PRESTON HOUSE

.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 at 102F and 82F in two resident bathrooms. Ensure hot water is between 105-116F.

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 throughout the facility in bathrooms, Laundry room, back hallway and under the bed in rooms 214, 121, 103, 106, 109, 111, 116. Cleaning needed and keep clean.

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 bowl and sink in 116. Observed soiled salon sink in building 1. Observed soiled hand sinks and toilets in staff restrooms. Details cleaning needed and keep clean.

.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 stained toilet bowl in 112, stained toilet seat 106, loose toilet seat in 201 and 217. Observed soiled salon sink in building 1. Observed disrepair faucet in 201, and salon faucet/back flow preventer in building 1. Repair and cleaning needed.

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 in building 2 measured at 97F - 103F. Provide tempered water range between 105F and 116F at anytime. Point remain the same due to improvement.

General Comment: .1318 (a) Food, utensils, medications, and equipment used on medication carts shall be kept clean.- Observed plastic spoons stored in a ziplock bag on the medication cart, half portion of spoon side up and the other half- handle side up. Keep all the handle side up and spoon side down to prevent any contamination.

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 debris and dusts on flooring underneath the beds, corners of the rooms, behind furniture 105, 109, 214, 205. Detail cleaning needed and keep floor clean.

General Comment: .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 the facility is using an approved cleaning/disinfectant products located in janitor closet. When asked a housekeeper, no knowledge about contact time, how to clean effectively. According to conversation, observed only floor and glass cleaning bottles on a cleaning cart without labeled. All cleaning bottles should be on a cart ready to use, and should have clear labels/instructions.

.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 in building 1 measured at 90F -94F, and building 2 measured at 80F -104 F. Ensure to provide hot water between 105F and 116F at all time. Note: the facility called the company to come and check the water heater, the work to be completed this week according to maintenance.

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 toilets need better cleaning and keep clean. (114, 118). Observed spa room in building 2 need better cleaning around shower floor, corners, and crevices around grout tiles. Observed soiled hand sink in staff restroom in the break room. Keep and maintain clean.

General Comment: .1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices.- Observed no soap at hand sink in women restroom building 1. Observed no paper towels available in spa room building 1. Ensure to 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 has a partial backup water supply plan. The facility has a copy of “backup water supply plan checklist”. Ensure obtain a complete written plan for water backup supply according to the checklist and as outlined in notated rule. Points remain the same, as the facility is still working to complete the plan. NOTE: The facility filling out the checklist from the department guide, the facility will need to write a complete written plan that pertains to their own facility and have available upon request. Rule.1300 had emailed to director and discussed in detail with person in charge at the time of inspection.

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/stained toilets and handwashing sinks throughout the facility, both of salon sinks are soiled. All toilets, sinks need better cleaning and keep clean. Observed leaking sink in salon 1, need repair.

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 in building 1 ranged between 72F- 102F. The tankless heater is flashing light indicating malfunctioning. Repair needed and ensure to provide tempered water between 105F- to 116F.

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 has a partial backup water supply plan. The facility has a copy of “backup water supply plan checklist”. Ensure obtain a complete written plan for water backup supply according to the checklist and as outlined in notated rule.

REPEAT 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 has no records of chemical used to sanitize linens (provided by the facility) available at the time of inspection. The facility needs to request and keep a record on file according to this rule.

.1311 (b) Ventilation equipment shall be kept clean and in good repair. Observed very dusty ceiling vent in salon building 1. Need cleaning and keep clean.

.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 toilets throughout building 1 in need of cleaning and keep clean. Observed shower room in building 2 need cleaning and keep clean.

.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 has a partial backup water supply plan. Obtain a complete written plan for water backup supply as outlined in notated rule.

.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 facility just installed the laundry chemical machine with ECO lab. No records of chemical used to sanitize linens available at the time of inspection. PIC will request a record and keep on file when needed.

All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed boxes of patient care items on floor in storage room outside of building 1.