ECHELON 1

15A NCAC 18A .1607 All floors shall be kept in good repair. Observed wooden flooring damaged throughout facility.Repair.

15A NCAC 18A .1608 (b) Wall and ceiling attachments, such as light fixtures, fans, and vent covers, shall be kept in good repair. Observed touch up paint needed in residents rooms. Observed ceiling fan near kitchen with dust accumulation. Clean.

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 some shower floor tiles missing and black build up to shower tiles in bathroom of room 3. Observed staining to bottom of shower curtain liner in hallway bathroom.

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 some handles loose to cabinets in kitchen. Observed staining on couch cushions in living room.

15A NCAC 18A .1607 All floors shall be kept in good repair. Observed wooden flooring damaged throughout facility.Repair.

15A NCAC 18A .1608 (b) Wall and ceiling attachments, such as light fixtures, fans, and vent covers, shall be kept in good repair. Observd small hole in ceiling in room 1. Observed ceiling plaster peeling in room 2 and 3. Observed touch up paint needed to walling, baseboards, door frames, and window trimming throughout facility.

15A NCAC 18A .1609 (b) Ventilation equipment shall be kept clean and in good repair. Observed dust accumulation to ceiling vent in living room. Clean.

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 some shower floor tiles missing in bathroom of room 3. Repair.

15A NCAC 18A .1614 (b) Outside waste containers shall be kept covered with tight-fitting lids when not in use. Observed lid missing to outside dumpster.

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 loose handles to cabinets in kitchen. -General comment.

15A NCAC 18A .1621 (d) The residential care facility shall have personal protective equipment on-site for employees to use and a written procedure for employees to follow when responding to vomitus or fecal matter on facility surfaces. The procedure shall specify the actions that should be taken to minimize the exposure to vomitus or fecal matter. Facility did not have copy of required procedure plan. EHS emailed facility a copy of procedure plan. -General comment.

Observed flooring in need of repair in the laundry room. **15A NCAC 18A .1607 All floors shall be kept clean and in good repair.

Observed walls in need of repair in bedroom 1, bedroom 2 and near the entrance. Observed ceiling in need of repair in bedroom 3. Observed ceiling in need of repair in the laundry room. **15A NCAC 18A .1608 (a) The interior walls and ceilings, including doors, window, and window trim, shall be kept clean and in good repair.

Observed dresser handles missing in bedroom 1 and bedroom 2. Observed dresser drawer in need of repair in bedroom 3. Observed blinds in need of repair in the kitchen. **15A NCAC 18A .1617 (a) Furnishings, including furniture, curtains, draperies, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair.

Observed torn blanket in bedroom 1. Observed small hole in linen in bedroom 2. **15A NCAC 18A .1617 (b) Clean bed linen in good repair shall be provided for each resident and shall be changed when no longer clean.

Observed shower tile in need of repair and toilet lid missing in bathroom in bedroom 3. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed dresser drawer missing in bedroom 1. Observed cabinet handles missing in bathroom 2. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Observed walls in need of painting and repaired in the home. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

An indicating thermometer shall be located in each refrigerator. 15A NCAC 18A .1620 (a). Observed no thermometer in refrigerator.

All equipment and utensils shall be so constructed as to be easily cleaned and shall be kept in good repair. 15A NCAC 18A .1618 (a). Observed rusting around oven inlets. Observed handle on 1 cabinet loose.

Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a). Observed shower tile cracking on floor in restroom 1. Observed black build up around tub in restroom 2. Each resident will be provided soap and individual towels. These towels will be stored separately after being used. 15A NCAC 18A .1610 (b). Observed no paper towels at handsink in both bathrooms.

All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). Observed vinyl blinds broken throughout facility.

The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608. Observed touch up paint needed to walls and baseboards throughout facility.

Ventilation equipment shall be kept clean and in good repair. 15A NCAC 18A .1609 (b). Observed detailed cleaning needed to ventilation equipment throughout facility.

Observed no thermometer in the refrigerator. **An indicating thermometer shall be located in each refrigerator. 15A NCAC 18A .1620 (a).

Observed dresser handle missing in bedroom w/ bathroom. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Observed markings on floor in first bedroom on the left. Observed floor tile missing in the bathroom within the bedroom. Observed linoleum torn in the laundry room and the kitchen. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.

Observed touch up paint needed in the bedrooms. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed shower curtain with build up in the bathroom within bedroom 1. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed floor damage in the laundry room and in the kitchen near refrigerator. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.

Observed ceiling peeling in bedroom 1 and bedroom 2. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed missing handles on the cabinets in the kitchen. Needs to be repaired. **All equipment and utensils shall be so constructed as to be easily cleaned and shall be kept in good repair. 15A NCAC 18A .1618 (a).

Observed dresser drawer off track in bedroom #1. Needs to be repaired. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). Observed torn blanket on the bed in room #1. Needs to be repaired/replaced. **Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).

Observed touch up paint needed throughout facility. Observed ceiling with water staining in the office where food is stored. Needs to be repaired. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Repeat: Observed handles/ knobs missing from the kitchen cabinets. Replace. All equipment and utensils shall be so constructed as to be easily cleaned and shall be kept in good repair. 15A NCAC 18A .1618 (a).

-Repeat: Observed the shower grout in both 2nd floor bathrooms with mildew buildup and shower curtain in master bedroom with mildew. **Toilet, hand washing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a). -Observed the laminate missing on part of the vanity. Paint or seal the raw wood area. Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

-Repeat: Observed the bed frame damaged in room 2, mattress cover torn on one of the beds in the master, stains on the comforters in bedroom 2. -Observed webs in the windows/behind the blinds. Clean. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Observed the paint peeling in the hall restroom, master bed room, and master restroom. The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed the grass/weeds really high in the back yard. The premises shall be kept neat, clean, adequately drained, and free of litter and vermin harborage. 15A NCAC 18A .1615(a).

Observed several cooking pans with damaged surfaces and some were not clean; interior cabinets with debris and handles missing or loose; dead insects inside cabinets. **All pots, pans and other utensils used in the preparation or serving of food or drink, and all food storage utensils, shall be thoroughly cleaned after each use. 15A NCAC 18A .1618 (c ). **Non-food-contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. 15A NCAC 18A .1618 (c ).

Observed the shower grout in both 2nd floor bathrooms with mildew and pink bacteria, one 2nd floor restroom with toothpaste residue, and shower curtain in master bedroom (beds 3 and 4) with mildew. **Toilet, hand washing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed the bed frame was damaged in a resident room (bed 2), two pillows damaged with exposed cushioning, mattress cover was damaged on bed 2, and 2 couches with damaged upholstery in the game room. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). Observed the comforter was torn/damaged on bed 2, and only one extra set of bed linens for all the residents. **Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).

Observed the carpet in the game room was heavily stained, the carpet tacks were exposed at the front entrance landing, the wood flooring was water damaged in the master bedroom outside restroom (beds 3 and 4), and the flooring was damaged near the washing machine. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.

Observed the walls were unfinished in some rooms, the walls needed cleaning near the bed in the master bedroom (bed3), and trim and molding needed cleaning and / or re-painting throughout the home. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed an AC filter with excess accumulated dust. **Ventilation equipment shall be kept clean and in good repair. 15A NCAC 18A .1609 (b). NOTE: Observed missing window screen in the resident bedrooms. **Screens must be present when window are open.

Observed old box spring and other dilapidated items inside and behind the shed / greenhouse, greenhouse over-run with vegetation and other debris, an old wood pile on the ground beside the driveway, spider webs on the exterior doors and windows, two birds nest on the porch columns, a rotten tree stump in the front yard, several holes in the backyard, and several exterior areas with deteriorated paint. **The premises shall be kept neat, clean, adequately drained, and free of litter and vermin harborage. 15A NCAC 18A .1615(a).

Observed debris collecting in cabinets in need of cleaning. Observed what appeared to be droppings present along corners of kitchen cabinets. Continue to utilize pest management program. **Non-food-contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. 15A NCAC 18A .1618 (c ). **Acceptable storage facilities include residential kitchen cabinets, which should be kept clean and free of vermin. 15A NCAC 18A .1618 (i).

Observed loose toilet seat in back right bedroom. Observed slow drain sink in back right bedroom. Observed white calcium build up present on shower head in hall restroom. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed dresser drawers in all 3 bedrooms damaged in need of repair. Observed loose handle at cabinet in kitchen. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).

Observed tile flooring downstairs not flush with wall. Observed transitional from bedroom to bathroom loose in back right bedroom. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.

Observed minor scrapes and scratches on walls in bedrooms. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Observed rip in screens located on front side of house. **Ventilation equipment shall be kept clean and in good repair. 15A NCAC 18A .1609 (b).

Repeat Non Compliance: Observed soap scum build up on 2nd floor hall bath, and corrosion on faucets in downstairs restroom. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Repeat Non Compliance: Observed worn/torn mattresses, rips in covers, and stains on blankets in rooms throughout facility. Observed curtain ripped in in bedroom 2. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a).**Clean linen shall be stored and handled in a sanitary manner and separate from soiled linen. 15A NCAC 18A .1617 (c ).

Observed clothes on floor in bedroom #3. Storage shall be provided to keep storage off floor. **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).

Repeat Non Compliance: Observed kitchen flooring ripped near entrance to dinning room. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.

Observed tear in ceiling from upstairs leak. Water damage apparent at seam in ceiling. **The walls and ceilings of all rooms and areas shall be kept clean and in good repair. 15A NCAC 18A .1608.

Repeat Non Compliance: Observed big hornets nest at back door downstairs, and 3 wasp nest present under front door covering at front door. **Effective measures shall be taken to keep insects, rodents, and other vermin out of the residential care facility and to prevent their breeding, harborage, or presence on the premises. 15A NCAC 18A .1615 (a).

Observed the kitchen drawers with debris and oven with food debris.**Non-food-contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. 15A NCAC 18A .1618 (c ).

Observed the toilet seat was cracked, the shower door was cracked and had soap scum in the 2nd floor hall bath, the shower curtain had mildew and the sink pipes were leaking into the cabinet.**Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).

Observed broken blinds and dust blinds throughout the home, all beds had stained bed spreads, the mattress in bedroom 2 was worn/torn/thin, and some furniture was dusty.**All furniture, mattresses, curtains, blinds and other furnishings shall be kept clean and in good repair.**Bed linens must be changed/washed when visibly soiled.

Observed te bedroom floor was water damaged (double room), and the floor had a missing tile at the sink in the 1st floor bathroom.**Keep all floors clean and in good repair.

Observed holes in the walls in bedroom 1, and the exerior shed (attached to the home) w/deteriorated wood and damged paint.**Keep all walls and ceilings clean and in good repair.

Observed no functioning light in the game room, 1st floor hallway, and the storage room. **Keep all lighting fixtures in good repair.Observed the window AC units with dusty filters throughout the home, windows with spider webs and debris (exterior). **Keep ventilation clean.

Observed 4-5 wasp nests on the front porch with several wasps present.**Provide and maintain effective pest control.