KELLY STREET HOME

15A NCAC 18A .1607 All floors shall be kept in good repair. Observed one floor piece missing in doorway of bathroom 2. Needs repair.

15A NCAC 18A .1610 (a) Residential care facilities shall provide toilet, handwashing, and bathing facilities that are available for use by residents and employees that are kept clean and in good repair. Observed pink build up in bathroom 1 shower head and some build up around edges of the shower. Needs cleaning.

15A NCAC 18A .1617 (a) Furnishings, including furniture, curtains, draperies, and blinds, shall be kept in good repair. Mattresses shall be kept in good repair. Observed kitchen cabinet missing a door. Observed mattress in one bedroom peeling. Observed mattress in one bedroom with large and deep bend in the middle of one side. Needs replacement.

15A NCAC 18A .1610 (a) All residential care facilities shall provide toilet, handwashing, and bathing facilities that are available for use by residents and employees. These facilities shall be kept clean and in good repair. Observed pink build up on the bottom of shower curtain in bathroom 2. Observed minor build up on shower tiles and door in bathroom 1. REPEAT

15A NCAC 18A .1617 (a) Furnishings, including furniture, curtains, draperies, and blinds, shall be kept in good repair. Mattresses shall be kept in good repair. Observed doors missing on kitchen cabinets. Needs repair.

15A NCAC 18A .1620 (c) Cold holding equipment shall be provided with an indicating thermometer that is accurate to +/-3 degrees F. Observed no thermometer in refrigerator. Needs thermometer.

15A NCAC 18A .1608 (b) Wall (doors, windows and window trim) and ceilings and ceiling attachments (light fixtures, fans, and vent covers) shall be kept in good repair. Observed paint peeling in room bedroom 2. Observed minor touch up paint needed throughout facility.

15A NCAC 18A .1610 (a) All residential care facilities shall provide toilet, handwashing, and bathing facilities that are available for use by residents and employees. These facilities shall be kept clean and in good repair. Observed pink build up on the bottom of shower curtain in bathroom 1. Observed minor black build up on shower tiles in bathroom 2. Observed brown build up under toilet lid in bathroom 2.

15A NCAC 18A .1617 (a) Furnishings, including furniture, curtains, draperies, and blinds, shall be kept in good repair. Mattresses shall be kept in good repair. Observed laminate behind 2 compartment sink in kitchen with black build up and peeling and in need of repair.

15A NCAC 18A .1621(d) the residential facility shall have gloves, personal protective equipment, disinfectant, individual disposable towels, and a coagulating agent onsite for employees to use and a written procedure for employees to follow when responding to a vomitus or fecal matter on facility surfaces. The procedure shall specify the actions that employees shall take to minimize the exposure of employees, residents, guest, food, and additional surfaces to vomitus or fecal matter. EHS emailed facility new rules, new required vomit/diarrhea plan, and employee health policy. -General comment.

The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608. Observed brown staining on walling in room 2 and touch up paint needed.

Ventilation equipment shall be kept clean and in good repair. 15A NCAC 18A .1609 (b). Observed general cleaning needed to wall vents in hallway.

The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608. Observed wall scuffs and minor damage throughout facility. Minor damage around furniture and sitting areas.

Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a). Observed black build up inside the caulking of shower in bathrooms 2 and 3. Clean.

The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608. Observed minor scuff marking to walls behind furniture throughout facility.

Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a). Observed loose toilet seat in restroom 2. Observed black build up on the bottom of shower curtain in restroom 2. Observed black build up inside the caulking of shower in restroom 3.

All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). Observed pillow stained in room 2. Observed mattress peeling in room 3 (Marks room). Observed minor staining on mattress in room 6. Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).

Observed black buildup in the grout in the walkin shower. Clean. Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

-Observed a torn mattress in bedroom 3 and a large stain on the mattress in bedroom 5. Replace or provide a fully enclosed mattress cover. All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). -Observed a clean comforter stored on the closet floor in bedroom 3 and clothing on the closet floor in bedroom 2. Clean linen shall be stored and handled in a sanitary manner and separate from soiled linen. 15A NCAC 18A .1617 (c ).

Observed loose toilet seat in bathroom on the left side of the house. Needs to be tightened. Observed shower head with build up in bathroom on the right side of the house. Needs to be cleaned. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed mattress stained in back bedroom on the left side of the house. Needs to be cleaned. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Discontinue used soap and wash cloth in restroom (big restroom). Each resident should keep personal items stored separately. Observed rust running from handle in shower near laundry room. Each resident will be provided soap and individual towels. These towels will be stored separately after being used. 15A NCAC 18A .1610 (b). Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed torn sheet in room 3, stain on pillow case in room 3, stains on sheets in rooms 2 and 4, stain on pillow in room 5. Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).

Observed pink residue on shower in bathroom near laundry room. Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed damaged blinds in various rooms. All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Observed resident scooping ice into cup with hand. A scoop with a handle or through the dispenser on the door is to be used to get ice.**All foods, while being stored, prepared, served, and during transportation, shall be protected from contamination. 15A NCAC 18A .1620 (a).

Observed rust stains below grab bar in roll in shower. Water damaged cabinet below sink in 1 bathroom.**Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed minor wall damage behind bed in 1 bedroom. Water damaged wall behind washer. Damaged vinyl siding and pillar near downspout.**The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed silverware container with crumbs in it.**All containers and clean utensils shall be stored in a clean place. 15A NCAC 18A .1618 (f).

Observed one toilet seat with damaged finish and rust on shower tiles below grab bars**Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed boxes stored on floor in common closet. Paper towels stored below hand sink.**Rooms or spaces which are provided and used for the storage of clothing, personal effects, luggage, necessary equipment and supplies and for items not in routine use, shall be kept clean. 15A NCAC 18A .1616 (a).General Comment: One broken drawer pull on drawer below mattress.

Observed wall damage in laundry room near water hook-up, and in a couple bedrooms.**The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.General Comment: Observed lift station/sump pump near cleanout without a proper cover. **A cover is needed that completely covers sump area.

Observed the refrigerator ice shoot with pink bacteria build-up. **If ice is provided for residents, it shall be handled, transported, stored and dispensed in such a manner as to be protected against contamination. 15A NCAC 18A .1612.

Repeat Non-compliance:Observed the shower wall and grout with rust.**Toilet; hand washing; bathing; and laundry facilities shall be kept clean and in good repair. See rule .1610 (a).Observed no soap at the hand washing sink inthe exercise area. Supply soap and individual towels at each hand washing area. **Each resident will be provided soap and individual towels. These towels will be stored separately after being used. 15A NCAC 18A .1610 (b).

Observed some furniture and bedroom appliances with dust, a pillow was stained on a resident's bed, and the pinic table and benches need pressure washing. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).GENERAL COMMENTS: Eddie Minter was present during the inspection.#10 - Observed disposable cameras and other items were stored under the hand washng sink in the exercise area. **Do not store clean items under exposed waste water drains.