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Home My WebLink AboutMountain View Family Home Care 430112 07 11 17.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.# 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) 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 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 VisitWastewater:Municipal/Community On-Site System Municipal/Community On-Site SupplyWater Supply: 18 Catawba 2018430112 4 0 7 1 1 2 0 1 7 A MOUNTAIN VIEW FAMILY HOMECAREMOUNTAIN VIEW FAMILY HOMECARE 5276 OLDE SCHOOL DRIVE HICKORY 28602 5276 OLDE SCHOOL DRIVE HICKORY NC 28602 4 4 2031 - Levin, Paige 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 MOUNTAIN VIEW FAMILY 0 8 3 2 9 4 52018430112 1 hr 13 minutes5276 OLDE SCHOOL DRIVE HICKORY Flies present during inspection.14 N.C. Department of Environment and Natural Resourses Division of Environmental Health COMMENT ADDENDUM City: Street: ID: Name:MOUNTAIN VIEW FAMILY 2018430112 5276 OLDE SCHOOL DRIVE HICKORY N.C. Department of Environment and Natural Resourses Division of Environmental Health COMMENT ADDENDUM City: Street: ID: Name: General Comments: MOUNTAIN VIEW FAMILY 2018430112 5276 OLDE SCHOOL DRIVE HICKORY