ARBOR RIDGE AT HUNTERSVILLE

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 soiled shower floor in bathroom H-17 memory care, need cleaning. Keep clean.

General Comment: .1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices.- Observed no paper towels available at the dispenser in restroom sink H-14 memory care. Provide all hand washing supplies at all hand at anytime.

General Comment: .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 crumbs and debris under couch cushions in common area in memory care, cleaning needed. Keep clean.

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 soiled hopper toilet bowl in soiled utility room in memory care. Cleaning needed and keep clean. -0 pts-

General Comment: .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 temperatures mostly in AL measure between 94F in women restroom, 102F in A06, 99F in spa room, 102F in A07. In memory care : 103F in activities room, 102F in H16. Ensure to provide tempered water range between 105F -116F. -0 pts-

REPEAT: .1318 (a) Food, utensils, medications, and equipment used on medication carts shall be kept clean.- Observed plastic spoons stored in a cup container on medication cart at AL, half portion of spoon side up and the other half- the handle side up. Keep all the handle side up, and spoon side down to prevent any contamination. -1 pts-

REPEAT .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 the facility with the incomplete back up water supply plan. A plan needs to provide details and procedures of listed item in the guidelines checklist provided via email. The facility has an example/guide copy from EHS. Ensure to have a complete written of water back up supply plan available. -1 pts-

.1318 (a) Food, utensils, medications, and equipment used on medication carts shall be kept clean.- Observed plastic spoons stored in a cup container on medication cart in memory care, some spoon side up and some handle side up. Keep all handle side up, and spoon side down to prevent any contamination. -0 pts-

.1321 (b) Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution's food supply as described in rule .1321 (a). Such food shall be labeled with the name of the resident or employee that the food belongs to and the date the food was brought into the institution. Labeling as required by this Rule shall not be required for food items stored in employee-designated or individual residents' refrigerators or rooms.- Observed staff and resident foods inside refrigerator in nourishment room memory care without label and date that was brought to the facility. EHS discussed in detail proper procedures with care staff and manager in a unit at the time of inspection. NOTE: Items inside refrigerator need to be reorganized and discarded as necessary. Name and date labeling needed.

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 flooring underneath the beds, laundry room behind machines, need regular cleaning and keep clean. No point deduction at time.

.1311 (b) Ventilation equipment shall be kept clean and in good repair.- Observed minor dust cover on ceiling vents and AC filter in some apartments. Cleaning needed and keep clean. No point deduction at time.

.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 toilet, hand sink, shower floor need cleaning and keep clean (H17, H10, A14, tub room memory care). Observed soiled at the back of shower chairs in several apartment. Detail cleaning needed and keep clean. Observed soiled handrail in tub room memory care needs cleaning.

.1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices.- Observed no paper towels at hand sink in H10 and wellness room. Observed no soap available at hand sink in nourishment room memory care. Ensure to provide all hand washing supplies at all hand sinks at all times. .1312 (d) Handwashing facilities shall be located in an institution in accordance with 10A NCAC 13B .5411, 10A NCAC 13D .3201, 10A NCAC 13F .0305, .1304, and 10A NCAC 13K .1109, .1204, as applicable. Institutions that do not have a handwashing facility located in all areas required by this Paragraph shall not be required to install handwashing facilities if the institution has an approved hand hygiene program.- Observed completely blocked hand washing sink in soiled utility room memory care. Remove/clear path for access to hand sink for hand washing at all time.

REPEAT .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 the facility with the incomplete back up water supply plan. A plan needs to provide details and procedures of listed item in this violation marking. The facility has an example/guide copy from EHS. The facility started to work on the plan, ensure to use potable/non-potable correctly at the appropriate situation. Point stay the same. -0.5 pts-

.1316 (b) Refuse, recyclables, and returnables shall be stored in containers, rooms, or areas designated for the storage of refuse, recyclables, and returnables.- Observed one of the dumpster is missing a plug. Obtain a plug for that dumpster. Keep plug in place and close dumpster doors when not using.

REPEAT .1319 (c) Linens provided by the institution that are not clean shall be cleaned and sanitized in accordance with this paragraph. When hot water in washing machines is used to sanitize linens provided by the institution, the washing machines shall be operated in accordance with the manufacturer's instructions. When chemicals are used to sanitize linens provided by the institution, linens shall be washed in accordance with the following: (1) using a solution of at least 50 parts per million chlorine; or (2) using laundry sanitizer that is registered in accordance with 40 C.F.R. 152 and that is used in accordance with the manufacturer's instructions. - Observed the facility provides and combines all white sheets when washing. The facility washing machines are hooking up with chlorine bleach. According the housekeeper manager, the facility is contacting the laundry service company to obtain the records of a chlorine solution concentration. The facility is working on obtaining the record from the servicer and will keep on file.

REPEAT .1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed soiled oven (the base) in nourishment room in memory care. Need cleaning and keep clean. No point deduction at this time.

.1312 (d) Handwashing facilities shall be located in an institution in accordance with 10A NCAC 13B .5411, 10A NCAC 13D .3201, 10A NCAC 13F .0305, .1304, and 10A NCAC 13K .1109, .1204, as applicable. Institutions that do not have a handwashing facility located in all areas required by this Paragraph shall not be required to install handwashing facilities if the institution has an approved hand hygiene program.- Observed hand washing sink was blocked by stacks of boxes causing inaccessible to the sink and soap dispenser in clean utility room in memory care. Ensure to clear/rearrange the space and not blocking hand washing access at any time. -1.5 pts- .1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices.- Observed no soap in the dispenser in clean utility room in memory care. Provide all hand washing supplies at all hand sinks at all time.

REPEAT .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 the facility with the incomplete back up water supply plan. A plan needs to provide details and procedures of listed item in this violation marking. The facility has an example/guide copy from EHS. The facility started to work on the plan, ensure to use potable/non-potable correctly at the appropriate situation. Point stay the same. -0.5 pts-

General Comment: .1319 (c) Linens provided by the institution that are not clean shall be cleaned and sanitized in accordance with this paragraph. When hot water in washing machines is used to sanitize linens provided by the institution, the washing machines shall be operated in accordance with the manufacturer's instructions. When chemicals are used to sanitize linens provided by the institution, linens shall be washed in accordance with the following: (1) using a solution of at least 50 parts per million chlorine; or (2) using laundry sanitizer that is registered in accordance with 40 C.F.R. 152 and that is used in accordance with the manufacturer's instructions. - Observed the facility provides and combines all white sheets when washing. The facility washing machines are hooking up with chlorine bleach. According the housekeeper manager, the facility just switched the laundry service company and have no access to the records of a chlorine solution concentration at this time. The administrator is working on obtaining the record from the servicer and will keep on file.

General Comment: .1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed soiled oven (the base) in nourishment room in memory care. Need cleaning and keep clean.

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 soiled bathroom floor in H-01. Need cleaning and keep clean. -0 pts-

.1311 (b) Ventilation equipment shall be kept clean and in good repair. Observed dusty ceiling vent in laundry room AL wings and main hall way women restroom. Need cleaning and keep clean. -0 pts-

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 soiled toilet and restroom facility in H-01. Observed loose toilet seat in men restroom AL wing (fixed at the time of inspection). -1 pts-

.1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. Observed no soap and paper towels at a hand washing sink in salon room. Observed no soap in a storage room in memory care wing. Ensure to provide hand washing supplies at all hand washing sinks at all time. -0 pts-

REPEAT .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 the facility with the incomplete back up water supply plan. A plan needs to provide details and procedures of listed item in this violation marking. The facility has an example/guide copy from EHS -0.5 pts-

.1319 (e) Laundry areas and equipment shall be kept clean. Observed floor and wall behind washers and dryers in laundry rooms need cleaning and keep clean. -0.5 pts-

.1320 (a) All food service equipment and utensils shall be kept clean and in good repair. Observed soiled juice dispenser machine, coffee machine, and oven in nourishment room in memory care. Need cleaning and keep clean. -0.5 pts-

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 carpet floor hallway of bath, soiled utility, soiled linen, laundry room.. in a memory care side in need for vacuum and keep clean. Observed soiled floor in bathroom and inside the room H-19, need general cleaning.

.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 soiled toilet in room A-02 in AL unit and room H-04 in memory care unit, in need of cleaning and keep clean.

.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 signs in most the restrooms that staff have access to. CDI- Hand washing signs provided at the time of inspection.

.1312 (e) EPA registered disinfectants shall be used in accordance with the manufacturer's instructions. When EPA registered disinfectants are mixed and prepared by institution employees, a measuring device, chemical testing device, or the methods and devices prescribed by the chemical manufacturer shall be used to prepare the concentration of chemicals in accordance with the disinfectant's label and the manufacturer's instructions. Observed facility without manufacturer’s instructions of how to use to the cleaner/disinfectant properly and the amount of contact time on surfaces to effectively clean. When asked the housekeepers, all seems to described how to clean properly. Recommend the facility to obtain manufacturer’s instructions and ensure to train all staff and cleaning staff to properly clean.

.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 water temperature at 94F- 96F at hand sink in women restroom in memory care unit. CDI- Temperature fixed at 106F at the time of inspection.

.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 facility has missing information needed in their backup water supplies plan. The administrators are in the meeting at the time of inspection. Facility has a plan at the last inspection. Recommend to locate a full backup water supply plan and have it ready for such an event. EHS will email facility an example of the plan.***

.1316 (d) An institution's exterior premises, including parking lots, lawns, and walkways, and interior premises within the institution's building or buildings, shall be kept free of garbage, solid waste, yard trash, and pest harborages. Observed wasp nest, spiders webs hanging on the building outside in the courtyard at memory care unit. Remove all nests and check all around the building. Observed damaged trim under the gutter in courtyard memory care unit. Need repair.

.1320 (d) The food-contact surfaces of cooking and baking equipment, including microwave ovens, shall be kept clean. Observed soiled oven, in need of deep cleaning and maintaining clean in the nourishment room in memory care unit.

.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 milk temperature in the refrigerator at 44F. Recommend to maintain all TCS food at 41F or below. The ambient temperature of the refrigerator is 42F. The temperature of the refrigerator was adjusted down at the time of inspection.

.1324 (c) Institution employees shall comply with the requirements for exclusion from work and restriction due to communicable disease or illness required for food employees as set forth in Parts 2-201.12 and 2-201.13 of the Food Code incorporated by reference at 15A NCAC 18A .2650 as amended by 15A NCAC 18A .2652. NEW RULES. No point deducted. At the time of inspection, Employees Health Policy posters provided and recommend the facility to train staff about EHP to ensure compliance.

.1324 (d) The institution shall have gloves, personal protective equipment, disinfectant, individual disposable towels, and a coagulating agent on-site for employees to use and a written procedure for employees to follow when responding to vomitus or fecal matter on institution surfaces. The procedure shall specify the actions that employees shall take to minimize the exposure of employees, residents, guests, food, and additional surfaces to vomitus or fecal matter. Observed facility without Vomitus and Diarrhea plan and kits ready for such an event if occurred. V&D clean up procedures poster provided at the time of inspection. Recommend the facility to obtain the kit and have instructions/plan in placed.

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310 Observed scuffed walls in need of repair / touch-up painting in resident rooms # H-20

A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no disinfectant accessible in spa rooms.

Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed soap and paper towels not located at all hand sinks, including areas run by 3rd party (PT and beauty salon)

Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c). Observed in beauty salon used combs left in sink, dirty towels in storage room, clean towels in contact with floor, foam head rests used as lumbar support in chairs, surface soiled and no non-absorbent covering. Used nail files, nail files cannot be used on more than one person. Beauty salon needs to stay clean. Tub for what looked like it is being used to soak feet, must be cleaned and disinfected between users.