HomeMy WebLinkAbout8th Av 430093 06 09 15.LS.PDFN,C, Depareneint ofEnkircirricBait andNatural Resources
Inspection of
Residen tial Care Facil itv
(for, facilities, as de ed,v ith
not more than 12 residents)
Date of InspClig- o 6 / 0 9
Staters, Code-, A
Health Department
0 1 5 Current Facility ED
Old Facility D)
M
K11 U." I
0da--M
0 talien jy? in spection E] Name Change
F2]Trensient Non -Community [j]Non-Pubhc Water Supply E]yes B M�:�nspecfion Verification of Closu
Wastewater System, Mcommunity [k]On-Site System M HStatus Change
'blis Permittee- UNKNOWN
Name of Esta shment, NTH AV
Location Addren. 212 8TH AV N W Number of Residents, -
city: MICIMRT state: NC zip: 28601 Nbiling AddfM
Classification
cit,d; -
State: Zip,:
[j] Approved (20 or less demerits, and no 6-poinit demeMs) 0 Disapproved (more than 40 demerits or failure to improve provisional classification)
F1 Provisional (more than 20, but 40 or less demerits, or &Pdnt clement) Demerits Comments
1.:"INTER SUPPLY. Public supply; private supply approved 6 (J611)
11 '' 11 , 1111211 !111111!111111111!11111� illi�illillil�iiiiiiii����,�l:iliiliilll!�lil,
3, FO,OD SUPPLIE SXND PROTE CT10.X:
Supplies: All food clean, wholesome, no spoilage 6 (.1619)
Protection, Adequate during storage, preparation a—nTsersing, potentiallyhazardous food 45'T
or belovt,, or 140'F or abooe 5" all refrigerators N&ith thermometers 2" Pori, ground beef products,
poultry and stuffings, etc,, thoroughly cooked, meat and poultry salad, potato salad, etc,, handled
as required, no re-sming of portions once ;;;ed to an individual 4; food containers stored aboie
floor and protected from cons amnation 3, pets and other animal s not all o-,'resl ,Nte—m food is
prepared or star d, nor era sersi ng area (unle ss caged or otherise restri cted) 4 (1620) ...
4, FOOD SERVICE UTENSIS AND EQUIPMENT, Food senice utensils aced equips in good
repair and kept dean 4; e-adng and drinking utensils clean to §ybt and tour!:, cleaned after each
use, approved facilities 4, clean utensils property stored 2- substances containing poisonous
material not used for cl;arting or polishing eating or cooldug utensils 6; disposable items
property stored and handled, used only once 2 (16 18) ---------------- ...........
5, FOOD SERN710E PERSONS, Clean clothes, hands, and work habits 4 (162 1) ... ------
6, DRL'sXING WATER FACILMESI- ICE HA\DLNG: C ornmon drinking cups not used 4; ice., if
provided, handled and dispensed in a saintary manner 2 (-1612)
7. HOT AND COLD WATER: Adequate hot and cold tinter piped to points of use 4 (.1611)
S. TOIT ET: HA.\7DXVASHD;& LAUNDRY AND BATHN'G FACILITIES. Toilet, lavatory and
bathing facilities adequate, 4 -1 fixtures in good repair and kept r1m 2-1 soap and tons provided
2(.1610) ------------------ ---------- ---- '...' ----------- ----------------------------------------------------- ............
Q- B ED& LLXENFURX=RE. All furniture., mattresses, linen, drapes, blinds and similar items in
good repair and clean 2; bed linen dianged, as required 2; dean and soiled linens property stored
andhandled 2 (.1617) ........... ........ .............. . ................. ..................
10 STORAGE MISCELLANEOU & Rooms or areas provided for storage of dothes, personal effects,
lugga
ge., supplies and equipment kept clean 2; niedicatrons, cleaning supplies, pesticides and other
hazardous products pro perlycored as required 4 (1616) ........
11, FLOOR& In good repair I; kept clean 2 (1607)
12, WALLS AND CEILLNG& In good repair 1, kept clean 2
13, LIGHTING AN0VEN7M.ATION: Windovos and fixtures ingoodrepair I,' kept dean 2 (.1609)
14. VER-MINCONTROL PREMISE& Outside openings effectively screened orothen-vise protected
against entrance of tying insects, and flying , msects absent 4, et` jktive control of rode rats and
other vennin 4., approved pesticides properly used 4, premises near, clean, drained and free of litter
and re, in harticrages and breeding areas 2 (.1615) ........................
15, SOLID ANVASTES: Gar n standard con property otivered and stored, approved disposal
4'. containers- Stora9 ept clean 2'. b in suitable receptacles, approved storage and
disposal 2l (.1614 —
Rept Rei:eired T Of AL DEM E RIT SCORE
In sp ection by:
EHS 1,D.# 1896 - Sears, Luke
a I I
CommentSheetAttac,hed
El Yes XN 0
Purpow Gemmt Sm�,,!t rq4rees oe CcA ' sienfor H lb ssr%tts to adort rites go�vtir'ti The Mitaiion of icadditions I SANCAC ILA_ ortcfisrht rottwioftn ima"Wotforra to record ttA Ttsufts trade
series Wit I Care is to be used in, rs��Vk
9 . t0flulttt rhof0rM.Mrytis* snorgimlmdt�cet
copesfor orecop" fmch't oqps�Ml4esesscy(or nwa sareqvtedt. 3. copyrx the, ba I laahr, departmnt. Disposition Please fsfer to Re
tart;„ Distriat Heaft, spublulcratFfft Noft Cart tita Zh%oion ofArchwes & Hiewy Adchfional Drats way bt 0T4*r*4 R0110: Madsamce
(Courses 2-0H4-0)
EHS 2U94 (Rotiaei� 07,05). Emiroonettil Htcdth Senicts Sec-6on (Rerie,,, 0709)
N,C- Departnert of Environment and Natural R
Narmr
8TH AV
Tifut: Iii
'f 7
0
9
ID:
20184300,93
Tigre Out, Out-
tjo
CitY'. HICKORY
12 PAINT VIALLS AS NEEDED WHERE PAJNT IS CHIPPING.
N -C- Department of Envwc,nment and Natural Resourses, Ndfrl�'- 8TH, AV
Duman of Enwonmental Heath ID- 2018430,093
Street: 212 8TH AV NIN
City l HICKORY