THE HAVEN IN THE VILLAGE AT CAROLINA PLACE

General Comment: .1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair.- Observed slow drain in Charlotte room 302 need repair. Ceiling vent in the Asheville Spa room and Charlotte Laundry room need cleaning. Restroom baseboard wall in Charlotte room 308 needs repair.

.1312 (b) A sign shall be posted in each toilet room for institution employees, directing them to wash their hands after each visit to the toilet room and before returning to work.- Observed no hand washing sign in restroom hallway and half of the facility restrooms. Ensure to post hand washing signs in all restrooms.

General Comment: .1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. - Observed no soap and or paper towels in Charlotte room 302, Charlotte spa room and soiled utility room. Ensure to provide all hand washing supplies at all hand sinks at all times.

REPEAT .1313 (d) Institutions shall provide water heating facilities. Hot and cold running water under pressure shall be provided to carry out all operations. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities. - Observed hot water temperature measure at 119F in rooms 205, 214 in Asheville, 121F in the Charlotte spa, 123F in Wilmington room 411, 404, common area sink at 121F. Ice cream shop at 92F, common area sink in Asheville and Charlotte at 87F. Ensure to provide tempered water evenly throughout the facility at anytime. Point remain the same at this times.

Observed hot water above 116F in rooms 207, 214, 401 and in both spas. **.1313 (d) Institutions shall provide water heating facilities. Hot and cold running water under pressure shall be provided to carry out all operations. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities.

Observed dresser handle missing in rooms 305 and 410. Observed knob missing on sink cabinet in the bathroom in room 410. Observed pillow staining in room 305. **.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair.

Observed stain on linen in room 305. GENERAL COMMENT **.1319 (b) A resident's bed linens shall be changed when no longer clean.

.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair. Observed walls in kitchenette areas in need of cleaning.

.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair. Observed stains and debris in communal seating in Charlotte and Wilmington neighborhoods. Needs cleaning. REPEAT.

.1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed food debris in small reach-in cooler in kitchenette in Charlotte. Observed cleaning needed inside cabinets in Charlotte and Wilmington kitchenettes. Cabinets with minor scuffs/chips.

.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair. Observed wall scuffs in resident rooms and throughout hallways. Repair.

.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair. Observed stains and debris in communal seating in Charlotte and Wilmington neighborhoods. Needs cleaning. REPEAT.

.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair. Observed cracked shower tile in Wilmington spa room. Observed very small crack in Wilmington tub in shower room. Observed toilet paper holder missing piece in 306 and 415. Needs repair. REPEAT.

.1313 (d) Institutions shall provide water heating facilities. Hot and cold running water under pressure shall be provided to carry out all operations. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities. Observed hot water in rooms in Charlotte section at 103F. Needs to be 105-116F.

.1313 (e) The institution shall have a written plan to obtain a backup water supply in the event that the institution's primary water supply is interrupted for more than four consecutive hours. The written plan shall identify a backup water supply or alternate source of water that provides two liters of potable water per day per resident and institution employee for drinking and potable water for food preparation, hand washing, bathing, cleaning, dishwashing, laundry, and disposal of bodily waste. This may include a plan for relocating residents to a facility with a water supply that satisfies Paragraph (a) of this Rule. If an institution's primary water supply or backup water supply becomes unsafe for human consumption, then the water sources within the institution, such as sink faucets, shall be labeled or hooded to prevent their use, and the administrator shall provide potable water for use by the institution's residents and employees. Observed that facility did not have a back-up water supply plan that was readily available. Emailed checklist and plan example. Provide in both buildings. REPEAT.

.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair. Observed stains and debris in communal seating in Charlotte and Wilmington neighborhoods. Needs cleaning. REPEAT.

.1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed heavy rusting on ice cream parlor freezer. Needs repair. Observed debris in cabinets and drawers. Needs cleaning. REPEAT.

.1323 (a) All TCS food shall be maintained at temperatures required by Part 3-501.19 of the Food Code incorporated by reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A .2653 during storage, preparation, transportation, display, and service of the TCS food. Observed resident breakfast sitting out at ambient temperature < 135F and no labeling in kitchenette in Wilmington. Maintain temperatures 135F or more or have a TPHC plan where food is labeled with time removed from heat, and disposed of within 4 hours. REPEAT.

1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair. Observed threshold removed Rm 409. Floors with debris and build-up in storage closets and soiled utility rooms. Clean and organize all back of the house spaces.

.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair. Observed minor wall damage in common bathrooms.

.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair. Observed rusted toilet chair in rm 409. Cabinets door with loose hinge in bathroom, room 409.

.1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. Observed no soap/paper towels provided in resident rooms. Soap dispenser not reachable in kitchenettes.

.1313 (e) The institution shall have a written plan to obtain a backup water supply in the event that the institution's primary water supply is interrupted for more than four consecutive hours. The written plan shall identify a backup water supply or alternate source of water that provides two liters of potable water per day per resident and institution employee for drinking and potable water for food preparation, hand washing, bathing, cleaning, dishwashing, laundry, and disposal of bodily waste. This may include a plan for relocating residents to a facility with a water supply that satisfies Paragraph (a) of this Rule. If an institution's primary water supply or backup water supply becomes unsafe for human consumption, then the water sources within the institution, such as sink faucets, shall be labeled or hooded to prevent their use, and the administrator shall provide potable water for use by the institution's residents and employees. Observed that facility did not have a back-up water supply plan that was readily available. Emailed checklist and plan example. Provide in both buildings.

.1316 (a) All solid wastes containing food scraps or other putrescible materials shall be kept in leak-proof, non-absorbent containers which shall be kept covered with tight-fitting lids when not in use. Observed dumpster rusted through, needs replacing.

.1318 (a) Food, utensils, medications, and equipment used on medication carts shall be kept clean. Observed pill cups, water cups not stored properly on med carts. Debris in bottom of bag holding cups, cups in side holder without sleeves and holder soiled.

.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair. Repeat- Observed trash under common furniture cushions. Stained furniture.

.1319 (e) Laundry areas and equipment shall be kept clean. Observed laundry areas linty and need cleanup of spills and debris.

.1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed cabinets and drawers in kitchenettes need wiping of spills and food debris. Swinging door to kitchenette in Asheville neighborhood in disrepair.

.1323 (a) All TCS food shall be maintained at temperatures required by Part 3-501.19 of the Food Code incorporated by reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A .2653 during storage, preparation, transportation, display, and service of the TCS food. Observed 2 resident breakfasts in microwave < 135F and no labeling in kitchenette. Maintain temperatures 135F or more or have a TPHC plan where food is labeled with time removed from heat, and disposed of within 4 hours.

Observed stains on toilets in rooms 404 (Wilmington) and in 308 (Charlotte). .1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair.

Observed hot water ranging between 98-103F in various areas and rooms. Must be 105-116F. .1313 (d) Institutions shall provide water heating facilities. Hot and cold running water under pressure shall be provided to carry out all operations. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities.

Observed crumbs or stains on chair in common area in Charlotte, stains on chair in room 404, and cabinet needing to be cleaned in room 404. .1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair.

Observed stains on sheets and pillowcases in room 304 (Charlotte). Observed stains on sheets or mattress cover in room 404 (Wilmington). .1319 (b) A resident's bed linens shall be changed when no longer clean.

Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed soiled toilet seat and handle of toilet in room 415 in Wilmington wing.

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 water below 100F in rooms 403, 308 and spa for Charlotte and Wilmington wings.

All furniture, bed springs, mattresses, sleeping mats, draperies, curtains, shades, venetian blinds, or other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a). Observed cabinet door above toilet in bathroom of room 415 of Wilmington wing.

Observed corners near exit door needing to be cleaned (webs, spiders, etc.). Observed stained ceiling tiles in seating area. Sprinkler system being change out. Repair will occur after completion.

Wilmington—-Observed stains on toilet seat in room 403. Observed corrosion on faucet in room 403. Asheville—-Observed toilet stopped up/clogged with tissue in room 208.

Observed stains on patient lift in hall near room 408 Wilmington side.

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.

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.

Repeat: Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed wall damage in Asheville neighborhood room 202 behind recliner. Wall damage in room 413 in Wilmington neighborhood. Observed dirty ceiling tiles and dust buildup on ceiling vents in middle common seating area in the Asheville neighborhood and dust buildup on the wall in the laundry room.

Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed rusted toilet seat risers in room 207 and room 211. Observed the base of the toilet loose in room 215. Loose toilet seats in room 413 and both spa rooms in the Wilmington hall and the Asheville hall.

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 water temperatures at 120F+ in the Asheville spa room, hall restroom, Wilmington spa room and rooms 401 and 413 in the Wilmington neighborhood.

Repeat: Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observe stained pillow, pillow case and sheets in room 202 in Asheville neighborhood. Observed stained pillows in rooms 401 and 407 in the Wilmington neighborhood.

Repeat: Observed dust buildup on laundry room walls. Clean. Obseved the baseboard seperated from the wall in one of the laundry rooms. Replace. Observed residue on the dividing curtains in the Wilmington and Asheville spas. Remove and wash. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

Observed boxes of PPE, tissue, (and other items) stored on the floor. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).

Observed a torn comforter in rooms 203 and 310. Replace. Observed torn mattress cover in 203. Replace. Observed debris on the sheets in room 310. Clean. Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).

Continue to touch-up paint throughout in hallway area, back hallway area, laundry rooms, janitor closet and storage rooms. Repaint doors and door framings. Tightly secure loose rubber base molding and replace missing rubber base cove molding. Secure loose shoe molding in residents room 210. Wipe/clean walls in residents room private bathroom around toilet paper holders and hand railing. Tightly secure hand washing sinks to wall in 202 and anywhere else needed. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

Observed two pillow covering soiled on resident bed. Pillow covering change out at time of inspection. Clean chair cushion in room 202. Clean chair in common sitting area. Replace torn/damaged mattress on resident bed. Mattress replaced at time of inspection. Replace torn/damaged fall pad in resident room. Damaged fall pad replaced at time of inspection. All furniture, bed springs, mattresses, sleeping mats, draperies, curtains, shades, venetian blinds, or other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a).

Continue to replace damaged shelving and base of drawers in kitchenette area throughout facility. Non-food contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. See rule .1320 (c).