HomeMy WebLinkAbout2400 Tamarack Avenue (2) HEALTH INSPECTION RESIDENTIAL AND DAY FACILITIES
CERTIFICATION
8-1-08
STATE OF CONNECTICUT
DEPARTMENT OF CHILDREN AND FAMILIES
DIVISION OF ADMINISTRATIVE LAW AND POLICY
505 Hudson Street,Hartford, Connecticut 06106
Unit or Cottage Name: W 0A CQ n hAUA Of Ouk t'r eGt✓C`Yh
Facility Name:
Address: Z�U T(401 AA a�GIL 4
Soto
WATER SUPPLY:
1. Description of drinking water source: ✓ Public Well
2. If supplied by well water, has the supply been analyzed and found safe?
If so, When? Please attach lab results to this form.
SEWAGE DISPOSAL:
1. Private on-site septic system. Public Sewers ✓
2. Date system was last serviced/pumped
TOILET FACILITIES:
1.Number of toilets for females L for males Z Urinals__ Sinks Z
2. Toilets clean in good working order in good repair �{
3. Adequate lighting Ventilation Y Screening
SLEEPING QUARTERS(N/A for Day Programs and Clinics): _a
1. Is distance between beds proper?(3 ft. For single, 4 1/2 for double deck beds)?
Check for cleanliness: walls_ floor mattresses bedding
KITCHEN AND DINING ROOM:
1. Are dishes, silverware, etc. In good condition and clean? - ( / I u ✓
2. Is there sufficient hot water available: liar washing dishes`?
3. Is the home equipped with a dishwasher?-1— If so is it functioning properly?
4. Check for cleanliness: floors ✓ walls__u/tables ✓ counters ✓ sinks ✓
ventilation and air conditioning systems__,ee, appliances ✓ -Q^mo
5. Is refrigerator clean? I Is food adequately refrigerated and properly stored? r�l� JAA
6. Is food protected from dust? flies? _T__ vermin? _
7. Is kitchen screened? Is diningpoin screened? Y
8. Are covered containers provided for garbage? `110
9. Are food preparation & serving areas in compliance with Health Department requirements?
GENERAL:
1. Are all stairways free from obstruction?
2. Is the building apparently in good repair?
3. Are surrounding grounds kept clean?
4. Is housekeeping satisfactory? y
5. Are floor coverings safe and clean? y
6. Are laundry facilities adequate? JVI At Clean? In good repair?
LEAD INSPECTION(Child Caring Facilities Only
Has the facility had a comprehensive lead inspection? (ATTACH RESULTS)
Date of Inspection: Not applicable if house built since 1978:
FLOOR PLANS:
Please attach floor plans for all buildings used for sleeping or treatment purposes.
The attached floor plans have been reviewed and the maximum number of beds for children in each area meets with my
approval. The maximum capacity for sleeping
or treatment purposes by floor is :
1 st: ✓ 2nd: 3rd:
THIS FACILIT HAS BEEN INSPECTED BY ME AND
[`1 DOES [ ] DOES NOT
MEET ALL APPLICABLE HEALTH DEPARTMENT REQUIREMENTS
HEALTH INSPECTOR(Print or type name)
Signature:
Address:T� U III t. ,saAA ckY\Ld/ Date: L L Iy I I
Comments and Recommendations (use separate sheet if necessary)
HEALTH INSPECTION
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CONSULT 2 I NUR5E 47
0535ERVATION CON5ULT I
STATION ROOM
230 5.f. i 100 5.f. 100 5.f. 100 5.f. MULTIPURP05E TREATMENT I TREATMENT 2
I
300 5.f. 19G 5.f. 225 5.f.
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I
LocicERs D
roc
5TAFf`ROOM L3 TT
115 "LED MEDICAL
REDS TOILET M.C.
60 5.f.
ELEC. TOILET
I
El
I
H CLEAN I m x ROOM
82 5.f.
RECEPTION 327 5.f.
DINING I 217 5.f.
WAITING
237 5.f. 21 1 5.f. mw.
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STOR I
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5TAIR
Walden Behavioral Care
at Evergreen Walk -.Building 2
2f00 Tasssas�acTc�ivcnrse
Sos�th W4sdsor Connecrice.t I
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