Inspection Detail

Case Status: CLOSED

Inspection: 1392090.015 - 141795 - Countryside Manor Inc

Inspection Information - Office: Nc Department Of Labor - Winston-Salem

Inspection Nr: 1392090.015

Report ID: 0453720

Date Opened: 04/10/2019

Site Address:
141795 - Countryside Manor Inc
7700 Us Hwy 158
Stokesdale, NC 27357

Mailing Address:
7700 Us Hwy 158, Stokesdale, NC 27357

Union Status: NonUnion

SIC:8051

NAICS: 623110/Nursing Care Facilities

Inspection Type: Planned

Scope: Complete

Advanced Notice: N

Ownership: Private

Safety/Health: Health

Close Conference: 04/15/2019

Emphasis:

Case Closed: 10/02/2019

Case Status: CLOSED

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2			3		5
Current Violations	2			3		5
Initial Penalty	$2,275	$0	$0	$0	$0	$2,275
Current Penalty	$2,275	$0	$0	$0	$0	$2,275
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Latest Event
1.	01001	Serious	19100133 A01	06/27/2019	07/01/2019	$525	$525	$0	Z - Issued
2.	01002A	Serious	19101030 C01 III	06/27/2019	07/01/2019	$1,750	$1,750	$0	Z - Issued
3.	01002B	Serious	19101030 C01 V	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
4.	01002C	Serious	19101030 G02 II A	06/27/2019	07/01/2019	$0	$0	$0	Z - Issued
5.	01002D	Serious	19101030 G02 VII A	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
6.	01002E	Serious	19101030 G02 VII D	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
7.	01002F	Serious	19101030 G02 VII G	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
8.	01002G	Serious	19101030 G02 VII K	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
9.	01002H	Serious	19101030 G02 VII N	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
10.	01002I	Serious	19101030 H05 I	06/27/2019	07/01/2019	$0	$0	$0	Z - Issued
11.	02001	Other	19100303 G01 II	06/27/2019	07/01/2019	$0	$0	$0	Z - Issued
12.	02002	Other	19101200 E01	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued
13.	02003	Other	19101200 G08	06/27/2019	07/08/2019	$0	$0	$0	Z - Issued

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