Premises Information


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Name

THE HAVEN IN THE VILLAGE AT CAROLINA PLACE

Address

13150 DORMAN RD

City/State/ZIP

PINEVILLE

28134

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/7/2021

Final Score @ Grade

General Comments

No points deducted for the following: 13. Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). Observed hot water in Ashville between 91-94 degrees F. Maintenance supervisor adjusted temperature to 100 degrees F.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	2	Walls and ceilings cleanable, clean, good repair	No	No	No	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed stains on pillow case and black residue around ceiling vent above the bed in Ashville room 207. Observed black residue on ceiling vent in Ashville room 214. Observed black residue around ceiling vent in common seating area of Wilmington. Observed paint needing touched up on wall area near residents recliner in Wilmington room 410. Observed laundry room of Wilmington with hole in wall behind laundry door and laundry room wall needing paint touch up. Observed damaged wall baseboard in Wilmington hallway near laundry room. Repair.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed stained shower curtain in Wilmington Spa room. Clean shower curtain. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed broken toilet paper holder in Ashville room 214. Repair or replace.