HomeMy WebLinkAboutFood Service Establishment Inspection 77 r
EHS-106-Rev. INSPECTION REPORT STATE OF CONNECTICUT
� �ROUTINEINSPECTIO ❑ REINSPECTION
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH RATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF \ /
ESTABLISHMENT �/ and 5 0,0 b'N ESTABLISHMENT
CLASS
STREET —7 cL TOWN
ADDRESS / 7,I uo�n `� ' B'V a. S %A V"/ 1 Y ls-6r,
OWNER or INSPECTION OPERATOR DATE and TIME ci 1 7 0
Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date specified below.
SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS I VERMIN CONTROL
1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2
nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1
2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket,if used insects/rodents
24 Sanitization rinse(hot water-chemical) 2
FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets ¢ 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed,
temperature requirements during storage, equipment clean constructed as required,good repair,clean
preparation,display,service,and 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required
transportation equipment clean g 1
46 Floor,wall juncture covered
4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean
5 Potentially hazardous food properly thawed 2 1 48 Exterior walking,driving surfaces, 1
6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean
not reserved 29 Water source adequate,safe ¢ 49 Walls,ceilings attached,equipment properly 1
7 Food protected during storage,preparation, 30 Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
08 2
display,service&transportation provided as required surfaces as required.
Food containers stored off floor 50 Dustless cleaning methods used, 1
SEWAGE DISPOSAL cleaning equipment properly stored
9 Handling of food minimized 2 31 Sewage disposal approved ¢
10 Food dispensing utensils properly stored 1 32 Proper disposal of waste water 1 LIGHTING&VENTILATION
11 Toxic items properly stored,labeled,used ¢ 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors 1
PERSONNEL 33 Location,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required
12 Personnel with infection restricted ¢ 34 No cross connection,back siphonage,backflow ¢
DRESSING ROOMS&LOCKERS
CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1
13 Handwashing facilities provided, ¢ 35 Adequate,convenient,accessible,designed, ¢ provided,facilities clean
— personnel hariffig washed.clean installed
14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1
15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING
55 Establishment and premises free of litter,no 1
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
CONSTRUCTION&INSTALLATION 3ESullable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1
16 Food-contact surfaces designed,constructed, 2 d hand drying devices provided, and laundry
maintained,installed,located aste receptacles provided 57 Clean/soiled linens stored properly 1
17 Nonfood-contact surfaces designed, 1 58 No live birds,turtles,or other animals 1
constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL (except guide dogs)
18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately 2 40 Storage area/rooms,enclosures— 59 1 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area
1 indicated by sign(s)
41 1 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 60 Qualified Food Operator 3
4 3 2 '.L 1 3 RISK FACTOR VIOLA IONS N RED 61 Designated alternate 2
a3 62 Written documentation of training program 2
ar
TOTAL RATING Date Corrections Due Signature of rson in
186 DAYS SIGN E Inspecto
DESCRIBE DEFICIEN CONTINUATION SHEETS
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Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INITIAL(INSPECTOR) C INITIAL(PERSON IN CHARGh
Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager
Page_of_
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME O.F^ESTABLISHMENT v;�� TOWN 7 7 9 '7`p Woj RrC t4 13 W DATE OF INSP//ETCTION
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Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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Establishment: VT Motel Date of Inspection: 2 S c
ddress: '7-19 :S-Q' + Em'.4' 8%_V t�' Owner or Operator: A5
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re-served 4 31 Sewage disposal approved. 4$
-Potentially hazardous foods not re-served -Operating as required
11 Toxic chemicals. No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbagelrubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
7 onfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
18 Single service articles,storage,dispensing
8 Exterior walking,driving surfaces,good repair,clean
19 No reuse of single service article lls,ceilings attached,equipment property constructed,good
pair,clean.Wall&ceiling surfaces as required
20 Dishwashing facilities approved design,adequately constructed,
maintained installed located ustless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
1 Preflushed,scraped,soaked and racked loom free of steam,smoke odors
2 Wash water clean,proper temperature 53o corns&equipment hoods,du s,vented a
2.3 urate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 nfood-contact surfaces of utensils&equipment clean
55 Establishment and premises free of litter,no insect/rodent harborage,
8 Equipment/utensils,storage,handling no unnecessary articles
32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesyrovided,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean Voutine Inspection [3111einspection ❑ Preoperational Inspection
IN PE T R: PERSON IN CHARGE: Otbar Inspection:
'n• L '�ZJ Demerit Score: *Include demerits from page 1
1�, 4 3 2 1 Total Rating
si ature signature
print name print n e
(o 4 • 25 Ll X Z� S� {'I�Q-l� ZZ DATE CORRECTIONS DUE:
phone number title
11b;<V ;-� Wit' Page 2 of 2 plus continuation pages FocuseaInapecdoul/2ooz
Establishment: V Inspection Date: s- 5 .9 Time:ef-uo ow., REinsp
Address/City: —i—i9 -S4%A a &jp Health Dept: S,->%i � Class: 1t Y�3 4
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2.
RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/0 N/A IDNCJ KEY: C[complies] NIO[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
IF Allr'
A Food workers have no exposed infected lesions/burns
��� +4tedoCat �9n'pftrarn progr�tltt 2 B Personnel with infection restricted
�1Vetlsatirce,�whuies� e,ncnadu(#erated C /A 4
C Communicable disease of worker reported to local health director
A I Approved shellfish,finfish,meat&poultry USDA approved 13 Halir**ing faciit6es:praiyic d,.ha washed,deaD kC WO N/A 4
B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas
C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
E Handwashing at appropriate times
0
I OFF- �W- - 7
A Hot holding greater than or equal to 1400F. (Whole beef/porkroasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450 F. oi B Wounds covered adequately
C I Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted
0 1 A Approved sanitizeravailable/adequate concentration ofsanitizer
B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
Proper
B Properfood thermometer for product D
E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units 0
0
A Cloths and/or sponges in good repair and clean
A Produce washed
B Wiping cloths kept in sanitizer between uses
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly Food equipment clean,utensils clean,equipment interiors clean Now
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food contact surfaces clean
No pooling of eggs not cooked immediately 0
8 ood containers stored off the floor 11
0
Im '' t, A Soap/paper towels I drying device available
Dispenser(s)working: ❑Soap ❑Papertowel
A No unnecessary handling RTE and/or cooked foods with bare hands B
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)fordispensing food/ice 0
0 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome]
PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debbble items) Page 1 of 2
Establishment: J _S7 I,t Date of Inspection:
ddress: __7 �i ZYb A N r,Tc- &,3J Owner or Operator: 1
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 31 Sewage disposal approved.
-Unwrapped foods not re-served' -Operating as required
�r
-Potentially hazardous foods not re-served
11 Toxic chemicals. No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 401 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents
4 Flo s: Floor covering installed,constructed as required,good repair,clean
located
16 Food-contact surfaces designed,constructed,maintained,installed, 5 Floors graded,drained as required
6 Floor,walljuncturecovered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
18 7ingle service articles,storage,dispensing
481 Exterior walking,driving surfaces,good repair,clean
9 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment propedystored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
1 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
2 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
27 nfood contact surfaces of utensils&equipment clean 55 s blishmentandpremisesfreeoflitter,noinsectfrodentharborage,
28 Equipment/utensils,storage,handling no unnecessary articles
32 Proper disposal of waste water 56 Complete separation from livingisleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored property
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 PropertoiletfixturesprovIded,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish containers,adequate number,covered,
rodent proof,clean Routine Inspection ❑Reinspection ❑ Preoperational Inspection
Ot Inspection:
IN Pbjfit�v,PERSON IN CHARGE: Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
si n ture i� �'�� sign tur `_ � �j Q
C) t
print name rint 3
phone number title DATE CORRECTIONS DUE: — t 4_0
Page 2 of 2 plus continuation pages Focused Inspection 1/2002
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET CLASS 7—
NAME OF ESTABLISHMENT TOWN "7 '79 5D1-U.1 f—rctA ZLV6 DATE OF INSPECTION
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INSPECTION REMARKS
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INITIAL(INSPECTOR) v (VI— INITIAL(PERSON IN CHARGE)
0
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
Establishment: Inspection Date: 2-1 t y 1 x3x Time: 5\I 11101nsp REinsp
Address/City: 1 �o,- J ���l ��� Health Dept: ��'�. y3�roc�a Class: 102 3 4
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2.
RISK FACTOR ITEMS Listing is not inclusive of all possible debitable items C I N/0 I N/A 19NC I KEY: C[complies] N/O[not observed] N/A[not applicable]
_ . �g 3 DNC[does not comply] 0[other] RTE[ready-to-eat]
R , �s '� � � ��� _ � �� fit =°F so%iiKtei°fiiw"rt`?rife�#ign��`6AttI ea� � C 0 NIA 4
61 Deeignated lternate
62 Written documentation of training program 2 q Food workers have no exposed infected lesions/burns
B Personnel with infection restricted
1 Approved source,w1holesome,norradulterated C N/0 NIA 4 C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 Handvvastdng facilities prov+deA itandswasited,dart C WO N/A 4
B Food cans in good condition(not dented,rusty,bloated,leaking) VA Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoodslsafe B Handwash facilities in or immediately adjacent to toilet rooms -
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature 0 D Personnel hands washed,clean/Proper handwash procedure
E Handwashing at appropriate times
R�r ��aalds fpod mttt rtirlegtS[i�etrf,�x 4 0
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19 " dit in: tracs � � N/0 N/A 2
A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. 31�r VT I B Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted
0 A Approved sanitizer available/adequate concentration ofsanitizer
B Food-contact surfaces and utensils used for potentially
' ba hazardous food sanitized at least every 4 hours
A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer ❑final rinse temp
D Proper sanitizin rocedure
B Proper food thermometer for product E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units
0 0
5 s» _mob,�. < . �- , a
F,
display,service and transportatilo ara ry A Cloths and/or sponges in good repair and clean
B Wiping cloths kept in sanitizer between uses
A Produce washed
B Raw meats not storedlprepared near ready-to-eat foods
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 od containers stored off the floor
0
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available
B Dispenser(s)working: ❑Soap ❑Paper towel llo
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)for dispensing food/ice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken. N ♦To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N ases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language bar inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFO/DA: ♦ QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title of above person(circle all that apply):CFO DA Mgr Cook w er FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2