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HomeMy WebLinkAboutCarillon 400014 05 17 17.JH.PDFN. C. Department of Environment and Zatml Resources Division of Environmental Health Inspection of Hospitals, Nursing Homes, Adult Care Homes and Other Institutions Score 98 Date oflnsplChg: $ 5 1 1 7 Status Code: A Health Department 18 D 0 1 7 Current FacilitsID 2018400014 Old Facilitv ID Water Supply: Q M unicipallCommundy ❑ On -Site Supply Water sample taken today?Inspection 1:1Name Change CapaCin' [:]YesR]NO MRe-inspection [_-]verification of Closure Wastewater. nMunicipatlCommunity ❑On -Site System 0 1:1 Visit ❑Status Change Name ofEstablishment: CARILLON Permittee: CARILLON ASSISTED LIVING LLC Location Address: 1088 RADIO STATION RD Mailing Addr. Cit►-: NEWTON statim NC zip: 28658 City: State: zip: Dadatioms Fed'Harf Ikdatdow Ful Half FLOORS, WALLS AND CEILPGS: [1309, _1310] ❑ 2 ❑ 1 --%IISCELLXNEOtiS: [.1318] 28. Adequate items (OS C1! a6l) ❑ 1 0.5 1. Floors easy to dean, no obstacles, drains where needed " storage, area clean, properly stored ....... 2. Floors clean, carpet dcan, dry, odor free.•....•...•..•.•..•.•.... . ❑ 2 ©1 29- Map sinks provided and used----------------------------------------- ❑ 1 ❑.5 3. Walls and ceilings cleanable, dean, good repair .............. ❑ 2 01 30. vied cation carts clean, sharps containers affixed food and 021--11 LIGHTENG,X'E?`-TMATIO?-,NIOISTL-RECOhTROL: [1311] utensil shandledpropedy••••••.......................................... 4" Lighting at Ieast 10 foot can des 30 inches abave floor -__- ❑ 2 1:11 31_ Feeding syringes and oral suction catheters handled tube bags charged instructions 172 Ell 5. Ambient air temperature 65` to 85° F, equipment clean ....._ ❑ 2 ❑ 1 properly, -feeding per ---- 6. No evidence of microbial growth ........................................ ❑ 3 ❑ 1 .5 FUILNISIID GS AND PATIENT CONTACT ITE\LS: 7- Indoor smoking limited to dedicated smoking rooms ------- ❑ 2 ❑ 1 [.1319,.1312] 32. Furniture clean and in good repair. Mattresses clean, dry, TOILET, FLIN41)NV �SHL\G, LAL N -DRY AA -D BATHViG free........................................................................... 2 ❑ 1 FACILITIES: [.1312] 33" Linen changedwhen soiled Soiled linen handledpropedy 02 ❑1 8- Facilities canveniently located, clean and in goodrepair _ ❑ 2 ❑ 1 34. Laundry area and equipment dean, linen disinfected, clean laundry handled ❑2 ❑ 9. Toilet rooms free of storage, handwash signs posted ...... ❑ 1 E]. 5 stored and separately- ........................... 1 10. Bedpans, urinals, bedside commodes and emises basins❑ 1 ❑ 35- Patient contact items in good repair, properly stored, cleaned disinfected ❑ 1 ❑. 5 Properly cleaned and disinfected -------------------------------------- ---------- .5 and ................................................................. 11. Hand sinks used only for intended purpose .................... ❑ 2 ❑ 1 FOOD SERVICE L-TE\SILS AND EQ U P341EN-T: 12. Lavatories have mixing faucet or tempered water, soap, band hand drying device [.1320] 03 El1.5 Approved ❑2 ❑ 1 towel or --------------------------------------------- 36- utensils and equipment, cleaned and sanitized 13. Lavatory and bathing hot water between 100° and 116° F ❑ 2 ❑ 1 37. Activity kitchens used only for approved activities ........ ❑ 1 ❑ i5 14. Disinfectant accessible, properly used ............................... ❑ 2 ❑ 1 38. Handwash lavatory provided wberev�er food is handled . ❑2 ❑ 1 WATER SUPPLY: [.1313] FOOD SUPPLIES AND PROTECTION: [.1321, .1322, .1323E 39" Food 15A NCAC ISA 4 ❑2 c 1_. Approved water supply, no cross -connections... ............... ❑4 ❑2 supply complies with -2600 ----------- 40. Food brought b employees or visitors handled S yproperly ...... ❑ 1 E-1.5 16" Quantity and hot water sufficient, backup water supply pian ❑ 2 ❑ 1 41 iNfilk and milk products comply with 15A NCAC 18A -1200 ❑2 Ell DRI-NICr1G-%VATERFACILTTIES,ICEHA-N'DLV G: [.1314] ❑ 2 ❑ 42- Food protected Potentially hazardous food maintained at 45`F below, 140°F discarded 17" Nater foutrtaius clean, good repair, properly regulated- 1 or or or above, consumed or within 2 flours being from 1:14 ❑2 18- Drinking utensils properly handled -------------------------------"-- ❑ 2 1711 of removed temperature control - .----.---- 19. Ice protected, dispensed, equipment clean, in goodrepair ❑ 2 ❑ 1 43" Food storage units vNith thermometers, maintain temperatures❑❑ 1 L1. 5 44. Food stored above floor ........................................ ............ 5 LIQUID AND SOLID iVASTES [1315-13161 -1316] 45. No live animals where food is prepared or stored. Pets 20" Wastewater dsposed of properly ---------------------- 04 02 preventedfrom contaminating food utensils, equipment, 2 ❑ 1 21. Solid waste stored properly, areas dean, facilities for ❑4 ❑2 condiments, pets excluded and tables cleaned before meals -07 cleaning............................................................................ 22. Solid waste disposed of Sequently, no insect breeding or ❑ 2 ❑ 1 EMPLOYEES: [.1324] 46. Clothing dean, no tobacco used while handing food-- ❑ 1 ❑ • 5 rruisance ........................................................................... 23. -Medical wastes hand ed and disposed of properly .......... ❑ 2 El 47_ Hands properly washed or decontaminated --------------------- ❑ ❑ 3 1.5 48. Fersons Kith infections excluded from food service work ❑2 Ell VEILIILti CON'TROL,PRE'ISES: [.1317] ❑3 ❑1 5 24. Vermin excluded................................................................ 25. Approved pesticides properly stored and han died .......... ❑ 2 F-11 26" Premises dean, no breeding places or rodent harborage ❑ 2 ❑ 1 27. Pet areas dean, veterinary records available .................... 02 01 Inspection by: TOTAL 2 Rept Received bti'. • Nr W Additional Comment Sheet Attached ❑ Yes +❑ N O EHS I.D. = 1654 - Huffman, Jason INSTRUCTION r illva 5requiesCxCoaaissnafocHUMStriAstoaWsultzImsmogv*seaintbsofialicuions.ISANCAC18A.1304sp"itsCx c onoMs d m h+£K[ba form oo rocxd sFa . :.gin` vt I faciltiits" Tho forms isdnebped to bemedatratinjnapectioas ofoephmags, mildfW& homes, lid similar intimions. Praparafioi- Local eawtheform�.rn cin"Cdon. pnpareas oririzdaad rse, Copia fw;1.Orijinlto be 1eh ailh the adrainatsat w or maasttr.1. Copy for Ow Ind heath depanmot. coqfortlxU%voxawwatHealthSan,cesSemon,DivemofU%ir1Heath.t)hposits°arThisfoammaybedeeeoA6itauordawewitSawifoLS"8b,bapectioaMoule,ofdlaRecordsRetemimsadDisposion Sdw&ge for CotmtyVatrict Health Dapaasmeonwhch x published by the North caroliaa Di Igion of Mchim aadHietosy" Adddwnal foram may be ordered from' Div*= of EaviroamenniHeaah, 143.1 Ngsii Sethi[! Censer, Raleip . N -C 2'649 16.2 - (Ccuria 5'41-00) EHSr213 (Re'iaad 7.45) Ew4roramtsl Heath Services Secsim (Review 7 108) FF 3 N.C. Department of Environment and Natural Resources Name: CARILLON Division of Environmental Health ID: 2018400014 Street: 1088 RADIO STATION RD COMMENT ADDENDUM City: NEWTON REPAIR SEAMS IN BATHROOM FLOORS --SPA, RESIDENT ROOMS Time In: 0 9 0 9 ❑Q a m[71pm Time Out: 1 1 : 4 3 Folam EjPm Total Time: 2 hrs 34 minutes REFINISH PAINTED TRIM IN RESIDENT BATHROOMS --DAMAGE FROM WALKER S/WHEELGHAIRS REPAIR WALLS IN PATIENT BEDROOMS --DAMAGE FROM CHAIRS .r" Spel I N.C_ Department of Environment and Natural Resourses Division of Environmental Health COMMENT ADDENDUM Name: CARILLON ID: 2018400014 Street: 1088 RADIO STATION RD City: NEWTON Vi sped I N.C. Department of Environment and Natural Resourses I Name: CARILLON Division of Environmental Health COMMENT ADDENDUM ID: 2018400014 Street: 1088 RADIO STATION RD CitY: NEWTON S0@i i N .C_ Department of Environment and Natural Resourses Division of Environmental Health COMMENT ADDENDUM General Comments: REPLACE WORN CHAIRS IN C HALL ACTIVITY ROOM Name: CARILLON ID: 2018400014 Street: 1088 RADIO STATION RD City: NEWTON