HomeMy WebLinkAbout8th Av 430093 06 21 11. LS.pdfN,C, Nsow"s
nar 1-160th ` 5 H ealth Department 18,
Demerit 'q Cone.,
Inspection of Date ofInsp/Chg 0 6 1 2 1 / I I Curnidt Facility ID 2018430093
Residential Care Facility
(For facilities,sisdeffivd.witIt Status Code, A Old Facility ID
not more t1ran 12 residents)
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"iWa,iir�C----�-[tY�-----"MNon-Transient,t4on-Coinmunii,v W" samplet k today" M,* . _ Inspection Name Change
[IT'ransient Non-Commundy [Eldon -Punic Water Supply Dyes Rd No i Re-rnspechon Verificahon of Gosure
Wastewater System, F*')-_ommuney M2, On -site Symern V:isd tarns Change
Name of Establishment Partuittee- UNKNOWN
N'urnber of Residents.,
LocationAddress: 212 8TH AV NW
city: HICKORY Suttr NC zip, 2,8601 Mailing Addr.
Classifiration
City., state,- Zip,
-
[E]Ajaproved (20 or less demerits, and no 6-point dernents) E] Disapproved (More than 40 dements a, failure to improve previsional classification)
Elprovisionai imore than 20, titit 40 or less deMents, or a &narl demerit) Demff its Cianiments
1, WATER SUPPLY: Public supply, prM*e sup ply appreared 6 (1,611y.
SEE COMENT SHEET ATTACHED
1 FOOD SUPPLIES AND PROTECTION:
Supplies: All food clean, w1wkwittv, on spiri][W 6 (1619)
Protectioxv, Adequate during storage, prelniation ZTmMng, potentially hassfrdoris food 457
or bdow. or 1401 orabove 51 all refrigerators v4th thermiometers 2, parK ground beef products,
potiltry and stuffings, etc., thorouglily cooked, rneat and poultry salad, potato salad, etc, handled
aireqwre4,norem rig ofpw,ionsonce . ed to wi individual 4w food conratnersetored above
floor and protectedf-ornrora rrati 2, p ds and othnuills, not all ooed vshm food is
prepared or stored, nor in xmdrigarea (urdess caged or otherMse restricted) 4 (1620) ..........
4 FOOD SFRVICE UTaTSILS AND EQUMMFI,4T- Food sft-vice utensilsand eciWianamt in pod
repair and kept dean. 4 ; eati n g and drailci ng ulewri Is clean to I it and toudi, d ean ed after each
use, approve4 ficifilieS 4 a of ean utensils properly A ored 2 - substairrie; containhill poisonous
naterial not used finr cleartiM or palls idin eatirig or Brae lkiM u(misi �,d;disposable itetts
propaly stored and handleA,useil ody once 2
5 FOOD SERVICE PERSONS Clean, clothes, hands, and waik habits 4 (162 1).. _ ..........
6 DEMING WATER FACLITES: ICE, HANDLR,10Canraon chinking cops not used 4-1 ice, if
provided. hantiled and dispenstiny sairitatyrnartner 2 ( 1612).
7. HOT AND COLD WATEK Ade-qtnite hot arid cold wder piped to points of use,l ( 1611)
8, TOLE, T, HAFMVASHIIGLAUNDRY AND B ATHUG FACLITIE& Toilet, lasnaloqand
bathing facilities adequate 4, firdures in, goodrepair mid kept clean 2;, soap and towels provided
2 ( 161 Q),_
9, BEDS LMH FURNITURAll furnriture, nvaflresses„ linen, drapes, blinds and arriflar it its in
good repour and clean 2, bed Unen clean as required 2p dean,suld soiled linens propelly stored
and handled 2 (• __ __ _ "__"
10, STORAGE: MISCELLAMOUS: Rooms arareasproinded ftstorage of clothes, personal effects.
lu&pge, supplies and equipmerst kept clean 21 rnedicalionss, cleaning supphez,peAicedes andtther,
h=dous products properly stored as required 4 (1616)
11, FLOORS: In good repair 1-1 kept clean 2 ......
12 WALLSAND CEILD-M: In good repair l',kept cleat 2 (16M_ ...... .....
t3 LIGHT8,T6 ANDVENTILATION: Windomand fixturts ingood.repau, 1� kept doext 16091)
14. VERMIN CONTROL. PREMISE& Outside op e mings effectively screened or othcrivise protected
against wrance of dynig insects, and flying iris ectsabse:414q effective control of rodentsand
other vennin 4, approved pesticides property used 4, prernises neat, clean, drained and, free of litter
and it tin harb cages and breedingareas 2 (1615), . ...... ..................... ... ...... _ ____
15. SOLID WASTE& Garbagem, standard cantata , properly covered and stored, approved disposal
4,cantainers.storagear sik t clean 2„ ckyrubb" sh in sintablereceptades, approved storage wid
itj�pocat
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TMALDETRIMT SCOR15
Canu-nent Sb,eet A tta che d
El Yes M No
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Coumy',D im at With Dwpamwnuwhih a pAabe4tfffw Nonh Cralau Dhrigion of Ardjw:& Tfi=y AAMflonabnat maybe mdavdAwa - D Heath, 16S2 Mil Stwx* Diter, Rtkidi, N C 2 709- 1632 ,
N-(--. Department of Environment and Natural ResourseS Name, 8TH AV Time W 0 0 0 L11 :err
,
— 1-1 Ism
Divisbn of Environmental Heafth IU 2018430093 Time Out, o 0 ') [Nam
— —E] p rn
Street! 212 8TH AV NW Total Time1 aiftte
COMMENT ADDENDUM Citil HlCKORY
4 CLEAN INSIDE OF DRAWER AND CONTAWERS THAT HOLD THE SILVER, WARE AS NEEDED.
SMOOTH AND EASILY CLEANABLE.
MR
N C Depatiment of Environment and Natural Resources
DivjsOn of Environmental Heafth
Name, 8TH AV
ID: 2018430093
Street: 212 8THAV NW
City. JjgcyOjjy-
N-C. Department o(Enviroanent and Natural Resourses
MMMMCEM
Divjs�on of Env¢ronmental Health
141101 M I LTJ I 41IL' -0
FeTTITTEITM-77MIT"ll - =1
JD- 2018430093
Street 212 8TH AV NW
OtY-1 HCKORY