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Home My WebLink AboutAdult Life Program Maiden 480001 06 22 17.GK.PDF N.C. Department of Environment and Natural Resources 0 18 Score: Health Department Division of Environmental Health Date of Insp/Chg: // 06222016 2018480001 Inspection of Adult Current Facility ID Day Service Facility A Status Code: Old Facility ID Classification: SuperiorApprovedProvisional Disapproved InspectionName Change Community 3Non-Transient Non-Community Water sample taken today? 1 1 Water No Yes Transient Non-CommunityNon-Public Water Supply 4 2 Re-inspectionVerification of Closure 2 Maximum CommunityOn-Site System 12 VisitStatus Change Wastewater System: 0 V y Capacit JUDY DAHLSTROM ADULT LIFE PROGRAM MAIDEN Name of Facility Operator: 28650 3390 SHEPHERD RDMAIDEN Address (City, Zip Code): DemeritsDemerits FOOD: (.3304, .3305, .3306, .3307, .3308, .3310) STORAGE: (.3317, .3320) *1. From approved sources, free from spoilage and *30. Medications and hazardous products properly stored 6 adulteration ..................................................................... 6 and locked ........................................................................ 2. Potentially hazardous food temperatures ......................... 31. Facilities provided for proper storage, kept clean ............. 5 3 3. Properly prepared, handled, packaged, and identified ...... BEDS, LINENS, FURNITURE AND EQUIPMENT: (.3321, .3322) 4 4. Not re-served ..................................................................... 32. Beds, chairs, cots, or mats clean and in good repair, stored 4 5. Protected at all times according to these rules ................... properly ............................................................................ 5 4 6. Refrigerators with thermometers, product thermometers 33. Mattress covers, individual linen provided ....................... 5 provided ........................................................................... 3 34. Linen clean, in good repair; properly handled and stored .... 4 FOOD SERVICE EQUIPMENT AND UTENSILS: 35. Other furniture and equipment easily cleanable, good repair 4 (.3304, .3306, .3307, .3309, .3310, .3311, .3312, .3313, .3314, .3316) clean ................................................................................... *7. Meets specifications for refrigeration, sinks, and dishwashing PERSONNEL: (.3323) equipment according to type of service ........................ 36. Approved hygienic practices, clean clothes, hair restraints 6 8. Meets requirements for handwash lavatories .................... where required ................................................................... 5 3 9. Meets specifications for other equipment and utensils, 37. Tobacco not used in food prep areas or areas occupied by 4 approved material and construction, in good repair .......... non-smokers ...................................................................... 5 *10. Food contact surfaces, including multi-use utensils, *38. Persons with communicable disease or a 6 properly washed, rinsed and sanitized ......................... communicable condition excluded from situations 6 *11. Single-service articles not reused ................................ in which transmission can reasonable be expected to 2 12. Single-use articles not reused ............................................. 6 occur, in accordance with 15A NCAC 19A.0200 .......... 13. Non-food contact surfaces clean ....................................... 4 *39. Wounds or lesions properly bandaged.......................... 6 14. Equipment and utensils, including single-service articles, FLOORS, WALLS & CEILINGS: (.3324, .3325) 4 protected from contamination ........................................... 40. Easily cleanable, durable, good repair, clean ......................4 15. Approved testing equipment for sanitizers, sanitizing LIGHTING AND THERMAL ENVIRONMENT: (.3326) solution provided .............................................................. 4 3 41. Maintained as required ..................................................... WATER SUPPLY: DRINKING WATER FACILITIES: (.3315, .3316) 42. Equipment clean and in good repair .................................. 2 *16. Supply meets 15A NCAC 18A .1700 or 15A NCAC COMMUNICABLE DISEASE CONTROL: (.3327) 6 18C .................................................................................... 43. Designated area for sick participants ................................ 5 *17. Hot water supplied and maintained in accordance with 44. Treatment room provided for day health facilities ............ 5 this section. ......................................................................6 HANDWASHING: (.3308, .3319, .3328) 18. No cross connections, backflow prevention device 45. Proper handwashing .......................................................... 5 provided ............................................................................ 4 WASTEWATER: (.3329) 19. Drinking fountains or drinking utensils of approved type, 6 *46. Wastewater disposed of by approved methods ............. 4 regulated, clean .................................................................. SOLID WASTES: (.3330) TOILET AND LAVATORY FACILITIES: (.3310, .3317, .3318, .3319) 2 47. Solid waste properly handled ............................................ 20. Toilets and lavatories provided, properly located ............ 48. Can cleaning facilities adequate and containers kept clean.. 5 2 21. Fixtures properly sized, cleaned, sanitized, cleaning and ANIMAL & VERMIN CONTROL: PREMISES; and sanitizing solutions provided ...................................... 4 OUTDOOR ACTIVITY AREA: (.3331, .3332) 6 22. Potty chairs, bedpans, urinals properly located, cleaned *49. Approved pesticides, properly used ............................... 4 and sanitized ...................................................................... 50. Effective control of rodents, insects, and other vermin ....... 4 23. Soap, disposable towels or approved hand-drying device; 51. No animals in food prep areas and no unrestrained animals 4 lavatories free of storage .................................................... 4 except as noted .................................................................. 24. Approved clothing changing facilities ............................... 4 52. Premises clean, drained, and free of hazards, vermin 25. Clothing change and bathing surfaces cleaned and sanitized harborages and breeding areas ............................................4 after each use; cleaning and sanitizing solutions provided SWIMMING & WADING POOLS: (.3833) 4 and labeled.. ....................................................................... *53. Designed, constructed, operated and maintained in accordance 5 26. Approved clothing changing methods by caregivers ......... with 15A NCAC 18A .2500 ............................................. 6 27. Test kits provided; sanitizer labeled ................................. 3 28. Clothing changing surfaces clean and free of storage ......... 2 29. Handwashing signs posted ................................................ *Indicates critical item (6-point demerit). 2 YesNo Comment Sheet Attached 1655 - Kain, Greg Signed _______________________________________________AGENT EHS I.D.# Division of Environmental Health Purpose: General Statute 130A-235 requires the Commission for Health Services to adopt standards governing the sanitation of child day care facilities. G.S. 130A-235 requires the facility to submit evidence to the Division of Facility Services or Division of Aging that it conforms to the standards. This form is to provide such evidence. Preparation: Local environmental health specialists shall complete the form every time an inspection is conducted and prepare an original and two copies to be submitted: 1. Original for Division of Child Development, N.C. Department of Health and Human Services. 2. Facility operator. 3. Local health department. Bk`rrhehb`shnm9Superior - 0-15 demerits, no 6-point demerit Approved - 16-30 demerits, no 6-point demerit Provisional - 31-45, or 6-point demerit Disapproved - 46 or more demerits, or failure to improve Provisional classification 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 4054 (7/05) Environmental Health Services Section (Review 7/08) am N.C. Department of Environment and Natural Resourses Name:Time In: ADULT LIFE PROGRAM : 0252 pm Division of Environmental Health ID: am 2018480001 Time Out: : 411 pm Street: 3390 SHEPHERD RD Total Time:1 hr 19 minutes COMMENT ADDENDUM City: MAIDEN N.C. Department of Environment and Natural Resourses Name: ADULT LIFE PROGRAM Division of Environmental Health ID: 2018480001 Street: 3390 SHEPHERD RD COMMENT ADDENDUM City: MAIDEN Name: N.C. Department of Environment and Natural Resourses ADULT LIFE PROGRAM Division of Environmental Health ID: 2018480001 Street: 3390 SHEPHERD RD COMMENT ADDENDUM City: MAIDEN N.C. Department of Environment and Natural Resourses Name: ADULT LIFE PROGRAM Division of Environmental Health ID: 2018480001 Street: 3390 SHEPHERD RD COMMENT ADDENDUM City: MAIDEN General Comments: