.1309; Staining was observed on the floor in room 208. Floors, walls and ceilings shall be maintained clean and in good repair. Remove staining from carpet.
0.0
7.
.1312; Toilet seat in room 109 had residue buildup on its surface. Toilet facilities shall be kept clean and in good repair. During the inspection, employee was called to clean the toilet seat. covering.
0.0
38.
.1320; Refrigerator in room 208 is soiled along the interior surfaces and needs to be cleaned. Non-food-contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. Clean refrigerator.
0.5
45.
.1323; Ambient air thermometer was missing in refrigerators in rooms 208, 303, and third floor med room. Each refrigeration unit shall be provided with an indicating thermometer of such type and so situated that the thermometer can be easily read.
.1312(d)- Soap was missing in the bathroom located in the whirlpool room (spa room). According to person in charge, this room has not been used since before COVID-19 due to showers located in resident rooms. Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. Provide soap at this location.
NOTE: There are no handwashing sinks located in the laundry rooms on all three floors. According to person in charge, staff does the laundry in these areas. Approved hand hygiene program observed in place.
0.0
17.
.1313(e)- Facility was unable to provide written documentation regarding a backup water supply plan. Written plan is kept in dining services and director of dining is out for the day. 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 back up 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. Person in charge was familiar with plan but was unable to provide the written plan during the inspection. Person in charge agreed to email plan to EHS and keep on file in assisted living building.
0.5
43.
.1321(b)- Employee food in activity kitchen refrigerators lacking a name and date. 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 Paragraph (a) of this Rule. 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.
0.5
45.
.1323(b)- Ambient air thermometer is missing in the activity kitchen refrigerator. Each refrigeration unit shall be provided with an indicating thermometer that is accurate to ±3 degrees Fahrenheit or ±1.5 degrees Celsius.
0.5
51.
.1324(c)- No information was able to be located regarding restriction, exclusion, and reporting illnesses for institution employees- employee health policy was only posted in the kitchen for kitchen staff`s use. 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. Illness action chart and form 1-B was emailed to person in charge to be implemented in the assisted living building and referenced by institution employees.
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General Comments
*Areas inspected include: Four resident rooms and all common areas, salon, spa room, storage closets, soiled utility, med rooms, facility laundry, and resident laundry.
There are no hand sinks present in the resident laundry rooms on all three floors. Med technicians and/or residents do the laundry in these areas. The building does meet the requirements for the exemption, as the building was built in 2002. Hand hygiene procedures put in place.
0.0
13.
Water temperatures around the building were very close to exceeding 116F. However, the hand sink in room A307 reached a temperature of 122F. Lavatory water is not supposed to exceed 116F. Please make adjustments.
1.0
43.
Thermometers are not present in several of the resident refrigerators. Each refrigeration unit that holds potentially hazardous foods shall be provided with an indicating thermometer that can be easily read. Replace thermometers.
0.5
General Comments
Due to COVID 19, Please follow CDC guidelines regarding social distancing, quarantine, and disinfecting. Inspection Lead by Lindsea Smith.
There are no hand sinks present in the resident laundry rooms on all three floors. Med technicians and/or residents do the laundry in these areas. Handwashing facilities shall be accessible to all areas where personnel may be exposed to bodily secretions an in med rooms, laundry areas and soiled utility rooms. A Hand Hygiene Program will be provided for future use.
1.5
13.
All resident rooms checked and med room hand sinks are reaching 85F max due to plumbing work happening throughout the building. Hot water shall be provided within the temperature range of 100-116F at all lavatories and bathing facilities.
0.0
14.
Test strips are not available for bulk disinfectant used in between patient use for shower rooms. Community shower rooms are not in use now due to residents having their own showers in the rooms.
0.0
34.
Main laundry area does not have a record of what strength the chlorine sanitizer is dispensed inside machine or records indicating the hot water temp for non bleached items reaches 160F for a minimum of 25 minutes. Linen provided by facility shall be washed with a detergent in water of at least 160F for 25 minutes for high temp and if low temp, linens shall be washed in at least 50 ppm chlorine or EPA listed laundry sanitizer.
1.0
43.
Thermometers are not present in majority of the resident refrigerators or in the activity room kitchen refrigerator. Each refrigeration unit that holds potentially hazardous foods shall be provided with an indicating thermometer that can be easily read.
Door frame leading to the nursing station is damaged/chipping and needs to be repaired. Walls and ceilings shall be maintained in a state of good repair.
1.0
16.
GENERAL COMMENT: Facility has a backup water supply plan, but stated there is no alternative bulk water supply on site. EHS recommends keeping enough backup water on site for 2 liters a day per resident for 2 days.
0.0
34.
Ecolab (facility’s chemical provider) has not recently left chlorine sanitizer concentrations for the laundry machine after their visits. Please contact Ecolab to leave the concentration readings for review during inspections.
Window screen in the shared shower room on the 3rd floor has lots of cobwebs. Ventilation shall be kept clean.
0.0
32.
Stained chair in the 3rd floor shared shower room. Furniture shall be kept clean.
0.0
39.
Floors 2 & 3: Observed red apples on a cart unwrapped with labels still attached to fruit. All food stored, transported displayed and served shall be protected from contamination. Remove sticker from apples (fruit) and wash fruit. Once dried, wrap apples in clear plastic wrap to protect from contamination. This process is not required for oranges or bananas. This is a repeat item.
2.0
General Comments
No signature of recipient due to COVID-19 pandemic.
Observed hot water in excess of 116 F in two resident rooms. Hot water must be 100 F to 116 F. The water must be adjusted so as not to exceed 116 F.
1.0
16.
There was no backup water supply presented during the time of inspection. There must be a backup water supply plan.
1.0
34.
Towels and wash cloths are commingled for washing in the independent living laundry side of the facility. There is no evidence that the machines are being serviced and checked for chemical sanitizing effectiveness. Commingled laundry must be sanitized at 50ppm chlorine (or equivalent). Keep documentation on site and readily accessible that the laundry is sanitized as required.
0.0
42.
Apples placed out for self service must be washed, stickers removed and wrapped or otherwise protected (such as protected with sneeze guards). May also supply a notice that they are not ready to eat and need to be washed prior to eating.
0.0
43.
Observed resident refrigeration and a group activity refrigerator in need of internal monitoring thermometers.
0.5
45.
Some residents in this facility have pets and there were no pet records available to be presented during the time of inspection. There must be vet records for pets that live on site and readily accessible.
3rd Floor Med Room: Observed a brownish residue on the pill crusher. Equipment / utensils shall be clean to sight and touch. Clean the pill crusher to remove brownish residue.
1.0
39.
Floors 2 & 3: Observed red apples on a cart unwrapped with labels still attached to fruit. All food stored, transported displayed and served shall be protected from contamination. Remove sticker from apples (fruit) and wash fruit. Once dried, wrap apples in clear plastic wrap to protect from contamination. This process is not required for oranges or bananas because the peel must be removed before eating the fruit. Education provided on handling.
0.0
43.
Various Rooms: Thermometer missing in room refrigerators. Each refrigeration unit shall be provided with an indicating thermometer. Place thermometers in resident refrigerators. Rooms viewed today include: A101, A103, A106,
A205, A207, A209, A214, A303, and A307. REPEAT
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General Comments
This inspection was performed by Margaret A. Gunter
Stained ceiling tile in laundry area on floor 3 needs repairing...
0.0
8.
Underside of assisted potty chair needs cleaning in room #A302...Whirlpool Had some scum in the bottom and needs to be cleaned ....
1.0
28.
Clean and organize the Janitor's closet on the 3rd floor...
0.0
36.
Noticed food debris and accumulation in multiple rooms..Detail clean residence refrigerators to remove all food debris and accumulation....
1.0
43.
Food thermometers shall be provided in all residents refrigerators that are provided by the facility..Thermometrs found in some rooms that were checked to day but some were not in good working order or not there...Replace non working thermometers and place a working thermometer in all provided refrigeration..
There are stained ceiling tiles in whirlpool room, shower room, and common area on 3rd floor. The ceilings of all rooms and areas shall be kept clean and in good repair.
1.0
14.
There is no disinfectant in shower room or whirlpool room. A supply of cleaning and disinfectant agents shall be accessible to bathing areas.
1.0
General Comments
Inspection was made with Mr. Cregg Barbour. Inspections were made in the whirlpool, shower room, rooms A301, A302, A207, A209, A212, mechanical rooms, and common areas.
Observed lighting in first floor public women`s bathroom (near AL side) is rather dim over part of toilet stall area. Also observed somewhat dim lighting in toilet room where one whirlpool is located on AL side. All areas shall be provided with sufficient illumination to effectively perform all operations, including cleaning, and shall have at least 10 foot-candles of light at 30 inches above floor (in all areas other than food service areas).
0.0
13.
Hot water in A105 room was at 118F, in A216 room it was 122F and at 2nd floor activity room sink it was 119F. Hot water in all lavatories and bathing facilities shall be between 100F and 116F.
1.0
16.
No hot water was available at mop sink/can wash off of men`s public bathroom on first floor. Provide hot running under pressure water at this sink, along with cold running water already present...During inspection, a back-up water supply plan was available in the event that the water supply is lost for more than four hours. However, it needs to contain more detailed information for the provision of drinking water and also include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, handwashing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste.
0.0
30.
Clean the soiled interiors of medication carts (especially in corners of drawers where meds are stored)...Found plastic pill and water cups stored on soiled surfaces of cart (on ends of carts). Also observed blood pressure cuff stored on top of pill/water cups on one cart. Clean the soiled surfaces where pill and water cups are stored. Do not store any patient equipment on top of pill/water cups.
1.0
32.
Clean the soiled areas under sofa/chair cushions in large sitting/activity room on AL third floor (remove trash and debris from these areas)...Clean the soiled/stained seat cushions on these sofas/chairs...Clean the soiled cupboards in the caregiver/medication rooms...Repair the torn vinyl cushion in one AL rehab area.
1.0
General Comments
NOTE: Ensure there are legible handwashing signs in each toilet room used for food service employees which direct them to wash their hands before returning to work.
Clean the soiled flooring in common laundry rooms on all three floors (in front of clothes washing machines)...Clean the soiled carpeting in hallways, especially near caregiver, dirty laundry storage rooms and in front of a few resident apartment doors.
1.0
5.
Clean the dusty ceiling vent/fan grates in bathrooms.
0.0
8.
In public women`s AL first floor bathroom, clean the soiled sides and edges of toilet stall partition doors.
0.0
12.
In first floor AL utility room, no paper towels were available at handwashing sink. Maintain paper towels at this sink at all times.
0.0
19.
In 2nd floor AL activity room where a common refrigerator/freezer is located, observed large amount of ice cubes in ice bin in freezer compartment. Residents have access to this exposed and unprotected ice and therefore, ice shall be removed. Ice machines and ice storage areas which are accessible to residents or the public shall provide ice through automatic ice dispensing equipment which prevents the contamination of stored ice.
1.0
29.
Hot water lever is missing (only saw hole in faucet fixture) at mop sink/can wash in 1st floor AL men`s public bathroom. Replace the hot water lever at this sink to provide hot running water under pressure at this sink at al times.
0.5
32.
Remove the accumulation of debris from under sofa seat cushions in 3rd floor AL lounge room. Clean the soiled cushions.
0.0
35.
Observed clean resident diapers/underwear stored on floor in clean linen closets. All patient care or consumable items shall be stored at least 8 inches above the floor to prevent contamination.
0.5
General Comments
COMMENTS ABOUT BACKUP WATER SUPPLY IN CASE OF WATER INTERRUPTION FOR MORE THAN 4 HOURS: The establishment shall have a plan to obtain a backup water supply in the event that the water supply is lost for more than 4 hours. The backup water supply plan shall provide for 2 liters of water per day per person for drinking. This plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing laundry and disposal of bodily waste...COMMENTS FOR CLEANING/SANITIZING OF SOILED LAUNDRY IN MAIN LAUNDRY FACILITY: If hot water is used, linen including sheets, pillow cases, absorbent pads, towels and wash cloths provided by the facility shall be washed with a detergent in water at least 160F for 25 minutes. If low temperature (less than 160F) laundry cycles are used, linens shall be washed in at least 50 ppm chlorine or an EPA listed laundry sanitizer shall be used in accordance with the manufacturer's instructions.
Depends and diapers stored on the floor of the clean linen closet on the 1st floor. Keep all patient contact items on shelving at least 6 inches off the floor. A fake tree and some wreaths are stored in the soiled utility room next to biohazard sharp containers. Store the tree and wreaths in a storage area where these items will not be contaminated.
0.5
General Comments
2. Room 102 has stained carpeting. The restroom in the wellness room has small holes in the wall. Repair. 21. Trash on the dumpster pad by the trash compactor/dumpster.
1st floor mop sink has a leak. 2nd floor mop sink has a leak and hot water faucet will not turn on. Needs to be repaired.
0.5
35.
Found depends on floor in 2nd floor clean linen closet and 3rd floor soiled utililty room. Also stored with non-patient contact items in nurses station and under drainpipes in patient`s rooms. Store patient contact items in a manner that they will not become contaminated.
0.5
General Comments
Room A208 has stained carpet. Need to add a disinfectant step to whirlpool wash. Inspection conducted with Melissa Ham as part of authorization.
Keep all items off the floor in the main storage room. (Single service cups) Boxes. Store 8" off the floor on shelving.
0.5
29.
The 2nd floor mop sink hot water is not working.
0.5
35.
Invert the single service medicine cups on the 2nd floor medicine cart. The store single service items in plastic sleeves in the 2nd floor activity kitchen. Room A 203 has depends stored under the drainlines of the sinks. Store in plastic containers with lids or 18" away from drainlines. Single service medicine cups stored next to sanitizer on the 2nd floor medicine cart. Store single service items away from sanitizer. Room A210 has a toothbrush behind the faucets on the handsink in the restrooms. Provide a toothbrush holder or move 18" away from the sink.
0.5
General Comments
Room 316 Food stored under drainlines of the kitchen sink. Store 18" away from the drainlines or in plastic containers. The 2nd floor activity kitchen cabinent is worn. I recommend that residents air dry their dishes in air drying racks instead of towels. Repair the worn wall in room A215. Room A203 has stained carpet. The shower handle is broken in room A203 bathroom. Room A203 does not have a thermometer. Provide. Trash on the dumpster pad.
Disinfectant that is used for the handsinks, bathtubs and toilets does not have the proper contact time, the disinfectant is applied and wiped down right away. The disinfectant according to the manufacturer`s directions must be left on for 10 minutes before wiping.
1.0
37.
Actibivty kitchen sink used to wash trash can lid. Use the mop sink room or utility sink or can wash to wash trash can lids.
0.5
General Comments
Paper towels, liquor stored under the kitchen sink drainpipes in the residents rooms. Alcohol, single service items away from drainpipes or in a sealed plastic container.
Replace water damaged ceiling tile in second floor dining/activity room. Verify ceiling leak in that area is repaired.
1.0
4.
Repair nonfunctional light fixture in community shower room.
1.0
General Comments
Keep items like adult diapers stored above the floor in clean linen closet. Clean cabinets and drawers in second floor med. room. Clean bin for cups on med. cart on second floor. Clean sinks in beauty salon. Clean bottom side of shower mats in resident rooms. Thaw freezers in med room refrigerators.
Running hot water temp. in second floor activity room and in resident room was 118 degrees F. to 126 degrees F. Adjust hot water flow in these areas. Hot water temp. should not exceed 116 degrees F.
1.0
28.
Keep items like adult diapers stored above the floor. Ex: In clean linen/storage closet.
0.5
30.
Clean drawers and bins on medication carts.
1.0
General Comments
Temp.of second floor medical supply refrigerator was slightly warm at 55 degrees F. Temp. controls were adjusted and internal temp. of cooler dropped to 37 degrees F. Keep unit on a colder setting for temperature. Thaw out freezer box on this unit. Verify that refrigerator door is completely shut. Themometers are needed in refrigerators in resident rooms to allow spot checks for cold storage temps. Cold foods like milk, dairy products, and meats must be kept at a temp. of 45 degrees F. or less. Check and change shower curtains regularly. One resident room on second floor had mold growth on shower curtain. Keep ice scoops or tongs to dispense ice from freezer bin in second floor activity room kitchen.
