HomeMy WebLinkAboutHoffman House 430091 08 08 17.pdfN.C. Department of Environment and Natural Resources
Inspection of
Residential Care Facility
(For facilities, as defined, with
not more than 12 residents)
Demerit Score:
Date of Insp/Chg: 0 8 / 0 8
Status Code: A
Health Department
a 0 1 7 Current Facility ID
Old Facility ID
18 Catawba
2018430091
Water Supply: I ❑X Municipal/Community On -Site Supply Water sample taken today? ® Inspection [:]Name Change
❑
❑Yes ® No ❑ Re -inspection F—] Verification of Closure
Wastewater: 0 Municipal/Community ❑ On -Site System ❑ Visit ❑ Status Change
Name of Establishment: HOFFMAN HOUSE
Location Address: 3555 BROOKWOOD DR
city: MAIDEN
Classification
State: NC Zip: 28650 Mailing Addr.
City:
Permittee: RODNEY & SINDY HOFFMAN
Number of Residents:
State: Zip:
❑X Approved (20 or less demerits, and no 6 -point demerits) ❑ 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) Demerits Comments
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)................................................................................................................................... ...
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 cooldng 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
andhandled 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)...................................................................
— SEE COMMENT SHEET ATTACHED —
15. SOLID WASTES: Garbage in standard containers, properly covered and stored, approved disposal Comment Sheet Attached
4; containers, storage area kept clean 2; dry rubbish in suitable receptacles, approved storage and ❑ Yes ❑X No
disposal2 (.1614) .......................... ...........................................................................................
Rept Received 0
TOTAL DEMERIT SCORE
U W1655 - Kain, Greg
01
Inspection by: EHS I.D.#
Purpose: General Statute 130A-235 requires the Co ssion for ealth 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 malting inspections ofresidential 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- 1 63 2,
(Courier 52-01-00)
EHS 2094 (Revised 07/05) /Environmental Health Services Section (Review 07/08)
N.C. Department of Environment and Natural Resoursesl Name: HOFFMAN HOUSE
Division of Environmental Health
COMMENT ADDENDUM
ID: 2018430091
Street: 3555 BROOKWOOD DR
City: MAIDEN
Time In: 0 9 a 0 0 am
❑ pm
Time Out: 1 1 1 5 0 am
❑ Pm
Total Time: 1 hr 55 minutes
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM
Name: HOFFMAN HOUSE
ID: 2018430091
Street: 3555 BROOKWOOD DR
City: MAIDEN
V
Spell
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM
General Comments:
Name: HOFFMAN HOUSE
ID: 2018430091
Street: 3555 BROOKWOOD DR
City: MAIDEN
I/
Spell