HomeMy WebLinkAbout8th Av 430093 05 22 13.ls.pdfN,C, Deparaneilt ofEnkiroancent andNatural Resources
Inspection of
Residen tial Care Facil itv
(for, facilities, as de ed,v ith
not more than 12 residents)
Date of InspClig- o 5
Staters, Code-, A
Health Department
0 1 3 Current Facility ED
Old Facility D)
M
K11 U." I
ommunfly
j0day? in spection E] Name Change
F2]Trensient Non -Community [j]Non-Pubhc Water Supply E]yes B M%:spection Verification of Closu
Wastewater System, Mcommunity [k]On-Site System M HStatus Change
'blis Pernsittee- UNKNOWN
Name of Esta shment, NTH AV
Location Addren. 212 8TH AV N W N umb er of Residen ts I -
city: MICIMRT state: NC zip: 28601 Nbiling AddfM
Classification
city -
State: Zip,:
[j] Approved (20 or less demerits, and no 6-poinit demerits) 0 Disapproved (more than 40 demerits or failure to improve provisional classification)
F1 Provisional (more than 20, but 40 or less demerits, tar &Pdnt clement) Demerits Comments
1, NITER SUPPLY. Public supply; private supply approved 6 (J611)
3, FO,OD SUPPLIE SXND PROTE CT10.X:
Supplies: All food clean, wholesome, no spoilage 6 (.1619)
Protection, Adequate during storage, preparation a—nTsersing, potentiaDy hazardous food 45'T
or belovt,, or 140'F or alrm;e 5" all refrigerators N&ith then meters 2" Pori, ground beef products,
poultry and stuffings, etc,, thoroughly cooked, meat and poultry salad, potato salad, etc,, handled
as required, no re-sming of portions once ;;;ed to an individual 4; food containers stored ale o;,e
floor and protected from cons amHatton 2-1 pets and other meals not all o-,'sed ,Nte—m food is
prepared or star d, nor era sersi ng area (unle ss caged or otherise restricted) 4 (1620) ...
4, FOOD SERVICE UTENSIS AND EQUIPMENT, Food senice utensils aced equipment in good
repair and kept dean 4; e-adng and drinking utensils clean to §ybt and total:, cleaned after each
use, approved facilities 4, clean utensils property stored 2- substances containing poisonous
material not used for cl;aidug or polishing eating or cooldug utensils 6; disposable items
property stored and handled, used only once 2 (16 18) ---------------- ...........
5, FOOD SERN710E PERSONS, Clean clothes, hands, and work habits 4 (162 1) ... ------
6, DRL'sXING WATER FACILMESI- ICE HA\DLNG: C ornmon drinking cups not used 4; ice., if
provided, handled and dispensed in a saintary manner 2 (-1612)
7. HOT AND COLD WATER: Adequate hot and cold Nvater piped to points of use 4 (.1611)
S. TOILFT: HA.\7DXVASHD;& LAUNDRY AND BATHN'G FACILITIES. Toilet, lavatory and
bathing facilities adequate, 4;, fixtures in good repair and kept clean 2-1 soap and toNNels provided
2(.1610) ------------------ ---------- ---- '...' ----------- ----------------------------------------------------- ............
Q- B ED& LLXENFURX=RE. All furniture., mattresses, linen, drapes, blinds andsinular items in
good repair and clean 2; bed linen changed as required 2; dean and Soiled linens property stored
andhandled 2 (.1617) ........... ........ .............. . ................. ..................
10 STORAGE MISCELLANEOU & Rooms or areas provided for storage of clothes, personal effects,
lugg
age., Supplies and equipment kept clean 2; niedicatrons, cleaning supplies, pesticides and other
hazardous products pro perlycored as required 4 (1616) ........
11, FLOOR& In good repair I; kept clean 2 (1607)
12, WALLS AND CEILLNG& In good repair 1, kept clean 2
13, LIGHTING AN0VE'N7M,.ATION: Windovos and fixtures ingoodrepair I,' kept dean 2 (.1609)
14. VER-MINCONTROL PREMISE& Outside openings effectiwly screened orothen-vise protected
against entrance of tying insects, and flying , irrsects absent 4, et` jktive control of rode rats and
other vennin 4., approved pesticides properly used 4, premises near, clean, drained and free of litter
and re, in harticrages and breeding areas 2 (.1615) ........................
a I I
15, SOLID AVASTE S: Garbage in standard containers, property Covered and stored, approved disposal Comment Sheet Attached
4, colitainers-, storage area kept clean 21 (try, rubbish in suitable, receptacles, approved storag
e and El Yes N o
disposal 2 IQ �'.' T I Of �U
Reptlte- -- DEMERIT SCORE 3
Inspectionbo EMS T.D. 1896 - Sears, Luke
PurpowGmtrtES tot �.*Iirxfttitions I�ANCAC ILA_ 1605 wxfilthe ini"Wot"oM tortcord dA:mUftS0f' C6cn3 znde
facAdas, "nil lostnti toteuwd in .e..kg Lnspectiomsofmidartur cana frtfties. Preparatiow L'XII er".'ionff*M'W halth 2P6,11imshattompitte d,,e1b= mty fta* d,,,, cortkxtttn inspecticn. lampare in orgirulmdtluet
copes for 1. Ongiral to she pem r Ln durp - .2.. Otte Cop" Ix aw a frof ttmiB &I Mqueatod). 3- Copy 1rb. but 1.aafth deparrmant. Dispeohm VBm se vefer to Records Retarib, tared niapmiimn So heduw 8.1rd . ; fm
Cm=-Dwortt Heaft, D"rm,"twtth a publishle bylbl Nara curoh" 1XVni'm or ArCivn & Hmmy AddiriDuAl forms as bt ordered moot: DrasionofEnvironrwo4al He4tq jst�' rjad zrvne Q-rues, Rs1.jo,,NC 27W- 163.1,
(Couritr3'-0H4-0)
DsN-R-2094(R4,,i3.,dT',,0i) Em-irotinantal Hadth Sftjc*& Section (Re,jew 07�0s,
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MMM. !III � I I i- -..- I I k--- --- Mnflzmmimm,;�
Street' 212 8TH AV NW
MIMMMs��
R,EPAINT CEILI
Time its: 1 1
Time Out i i
Total Time- 5 minutes
N -C- Department of Envwc,nment and Natural Resourses, Ndfrl�'- 8TH, AV
Duman of Enwonmental Heath ID- 2018430,093
Street: 212 8TH AV NIN
City l HICKORY