HomeMy WebLinkAboutHoffman House 430091 07 26 16.GK.PDFTOTAL DEMERIT SCORE
1. WATER SUPPLY: Public supply; private supply approved 6 (.1611) ...............................
2. LIQUID WASTES: Sewage and other liquid wastes disposed of by approved method 6
(.1613) ..........................................................................................................................................
3. FOOD SUPPLIES AND PROTECTION:
Supplies: All food clean, wholesome, no spoilage 6 (.1619)
Protection: Adequate during storage, preparation and serving, potentially hazardous food 45°F
or below, or 140°F or above 5; all refrigerators with thermometers 2; pork, ground beef products,
poultry and stuffings, etc., thoroughly cooked; meat and poultry salad, potato salad, etc., handled
as required, no re-serving of portions once served to an individual 4; food containers stored above
floor and protected from contamination 2; pets and other animals not allowed where food is
prepared or stored, nor in serving area (unless caged or otherwise restricted) 4 (.1620) ..............
4. FOOD SERVICE UTENSILS AND EQUIPMENT: Food service utensils and equipment in good
repair and kept clean 4; eating and drinking utensils clean to sight and touch, cleaned after each
use; approved facilities 4; clean utensils properly stored 2; substances containing poisonous
material not used for cleaning or polishing eating or cooking utensils 6; disposable items
properly stored and handled, used only once 2 (.1618) ...............................................................
5. FOOD SERVICE PERSONS: Clean clothes, hands, and work habits 4 (.1621) .........................
6. DRINKING WATER FACILITIES: ICE HANDLING: Common drinking cups not used 4; ice, if
provided, handled and dispensed in a sanitary manner 2 (.1612) ................................................
7. HOT AND COLD WATER: Adequate hot and cold water piped to points of use 4 (.1611) ..........
8. TOILET: HANDWASHING: LAUNDRY AND BATHING FACILITIES: Toilet, lavatory and
bathing facilities adequate 4; fixtures in good repair and kept clean 2; soap and towels provided
2 (.1610) .......................................................................................................................................
9. BEDS: LINEN: FURNITURE: All furniture, mattresses, linen, drapes, blinds and similar items in
good repair and clean 2; bed linen changed as required 2; clean and soiled linens properly stored
and handled 2 (.1617) ...................................................................................................................
10. STORAGE: MISCELLANEOUS: Rooms or areas provided for storage of clothes, personal effects,
luggage, supplies and equipment kept clean 2; medications, cleaning supplies, pesticides and other
hazardous products properly stored as required 4 (.1616) ...........................................................
11. FLOORS: In good repair 1; kept clean 2 (.1607) ........................................................................
12. WALLS AND CEILINGS: In good repair 1; kept clean 2 (.1608) .............................................
13. LIGHTING AND VENTILATION: Windows and fixtures in good repair 1; kept clean 2 (.1609)
14. VERMIN CONTROL: PREMISES: Outside openings effectively screened or otherwise protected
against entrance of flying insects, and flying insects absent 4; effective control of rodents and
other vermin 4; approved pesticides properly used 4; premises neat, clean, drained and free of litter
and vermin harborages and breeding areas 2 (.1615) ...................................................................
15. SOLID WASTES: Garbage in standard containers, properly covered and stored, approved disposal
4; containers, storage area kept clean 2; dry rubbish in suitable receptacles, approved storage and
disposal 2 (.1614) ..........................................................................................................................
EHS I.D.#
Community On-Site System
Water Community
Transient Non-Community
Non-Transient Non-Community
Non-Public Water Supply
Name of Establishment:
Disapproved (More than 40 demerits or failure to improve provisional classification)
Provisional (more than 20, but 40 or less demerits, or a 6-point demerit)
N.C. Department of Environment and Natural Resources
Division of Environmental Health Health Department
Current Facility ID
Old Facility IDStatus Code:
Date of Insp/Chg:
Demerit Score:Inspection of
Residential Care Facility
(For facilities, as defined, with
not more than 12 residents)
Wastewater System:
Water sample taken today?
State: NC Zip:City:
City:State:Zip:
Location Address:
Mailing Addr.
Permittee:
Number of Residents:
Purpose: General Statute 130A-235 requires the Commission for Health Services to adopt rules governing the sanitation of institutions. 15A NCAC 18A .1605 specifies the contents of an inspection form to record the results of inspections made of
residential care facilities. This form is to be used in making inspections of residential care facilities. Preparation: Local environmental health specialists shall complete the form every time they conduct an inspection. Prepare an original and three
copies for: 1. Original to the person in charge. 2. One copy for the supervising agency (or more as requested). 3. Copy for the local health department. Disposition: Please refer to Records Retention and Disposition Schedule 8.B.6., for
County/District Health Departments which is published by the North Carolina Division of Archives & History. Additional forms may be ordered from: Division of Environmental Health, 1632 Mail Service Center, Raleigh, NC 27699-1632, (Courier 52-01-00)EHS 2094 (Revised 07/05) / Environmental Health Services Section (Review 07/08)
Rept Received
Inspection by:
Demerits Comments
1
2
3
4
1 2
Comment Sheet Attached
1
V
2
** SEE COMMENT SHEET ATTACHED **
Yes No
Yes No
Approved (20 or less demerits, and no 6-point demerits)
Classification
Name Change
Verification of Closure
Status Change
//
Inspection
Re-inspection
Visit
18 Catawba
2018430091
0
0 7 2 6 2 0 1 6
A
RODNEY & SINDY HOFFMANHOFFMAN HOUSE
3555 BROOKWOOD DR
MAIDEN 28650
0
1655 - Kain, Greg
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM
Time In:
Time Out:
Total Time:
City:
Street:
ID:
Name::am
pm
:am
pm
HOFFMAN HOUSE 1 0 0 2
1 1 1 12018430091
1 hr 9 minutes3555 BROOKWOOD DR
MAIDEN
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:HOFFMAN HOUSE
2018430091
3555 BROOKWOOD DR
MAIDEN
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:
General Comments:
HOFFMAN HOUSE
2018430091
3555 BROOKWOOD DR
MAIDEN