HomeMy WebLinkAbout8th Av 430093 04 24 14.ls.pdfN,C, Deparoneet ofEnkiroancent andNatural Resources
Inspection of
Residen tial Care Facil itv
(for, facilities, as de ed,n, ith
not more than 12 residents)
Date of InspClig- o 4 i
4
Staters, Code-, A
Health Department
0 1 4 Current Facility ED
Old Facility D)
M
K11 U." I
0da--M
0 UKen jy? * ln spection E] Name Change
F2]Tra nsient N o n-C o mmun ity [j]N on-Pu blic W ater Supply E]yes B M2 %napecton Verification of Closu
Wastewater System, Mcommunity [k]On-Site System E] HStatus Change
'blis Pernsittee- UNKNOWN
Name of Esta shment, NTH AV
Location Addren. 212 8TH AV N W Number of Residents, -
city: MICIMRT state: NC zip: 28601 Nbiling AddfM
Classification
city -
State: Zip,:
[j] Approved (20 or less demerits, and no 6-poinit demeMs) 0 Disapproved (more than 40 demerrIs or failure to improve provisional classification)
F1 Provisional (more than 20, but 40 or less demerits, tar &Pdnt clement) Demerits Comments
1.:"INTER 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, potentially, hazardous food 45'T
or belovt,, or 140'F or abm;e 5" all refrigerators N&ith thermometers 2" Pori, ground beef products,
poultry and stuffings, etc,, thoroughly cooked, meat and poultry salad, potato salad, etc,, handled
as required, no re-sercing of portions once ;;;ed to an individual 4; food containers stored ale o;,e
floor and protected from coat amnation 2-1 pets and other meals not all o-,'sed ,Nte—m food is
prepared or s lered, 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-adrig and drinking utensils clean to §ybt and snarl!:, 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 wtedc habits 4 (.1621} ... ------
6, DRL'sXING WATER FACILMESI- ICE HA\DLNG: C omion 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 Nonter piped to points of use 4 (.1611)
S. TOIT ET: HA.\7DXVASHD;& LAUNDRY AND BATHIN'G FACILITIES. Toilet, lavatory and
badiing facilities adequate, 4 -1 fixtures in good repair and kept dean 2-1 soap and tolls provided
2(.1610) ------------------ ---------- ---- '...' ----------- ----------------------------------------------------- ............
Q- B ED& LLXENFURX=RE. All farniture., mattresses, linen, drapes, blinds andsinular items in
good repair and clean 2; bed linen changed, as required 2; dean and soiled linens property stored
andharidled 2 (.1617) ........... ........ .............. . ................. ..................
10 STORAGE MISCELLANEOU & Rooms or areas provided for storage ofclothes, personal effects,
lugg
age., supplies and equipment kept clean 2; niedications, 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-MIN PREMISE& Outside openings effectiwly screened orothen-vise protected
against entrance of tying insects, and flying , insects absent 4, efiktic.0 control of rode rats and
other vennin 4., approved pesticides properly used 4, premises near, clean, drained and free of litter
and re, in harborages 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, containers-, storage area kept clean 2, dry, rubbish in suitable, receptacles, approved storag
e and YeS N 0
disposal z" (.161jen ......
77777��
Rept Rei:eired J 4 T Of it, DEM ERR SCORE
In spection by EMS LD.# 1896 - Sears, Luke
co.
Purpow Gmtta1t Stsm .r fftkk::alto it To ISANCAC ILA_ 1605 Wxfisdoe mit-mof
totewad irntAflng kspectiona ofrasidetctW cafe facilkies. Preparadva: Local kfl"ionff*M'W t1celom mntio* d,,,, Peepant ocaginaladdle:
copies for 1. On giral to the peneon it durse - 2 . Ore copy 'W 4'A M*QM"SM5 RiMc y (Pr VMDVe M MTRstam. 3. Cop, for ftia locit 1.elfth deparrmwnt. Dispootim Vnn o@ vefer to Recds Retartb, t and Ditposition S- 1-dint S,P fm
CM m-Dartt Heaft, aPUb1WcatN'tI* \onh czolica Himmy Additional formsmay Ila ordered from: DrasionofEnvironmental He4aq 1*32 �Mad simce Qntor'
DENM
I111 111111 pg' I'll "1 1,1'' ''1' 1 '1'' 1111 Imill I 1� 11111 11� � 'I 'I 111111,11F, 111
wmm. !III � I I i- I k--- --- mnflzmmimm,;�
Street' 212 8TH AV NW
mlvnms��
REPAUNT WALLS JR BATMROOM AS 11EEDEn
REPLACE DAMAGED TILE IN FLOOR
REFINISH BATHTUB
Time its: 1 0
Time Out i o
Total Time: 4 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