HomeMy WebLinkAbout2023-11-30 - 100 Evergreen Way - Food Inspection ReportConnecticut Department of Public Health
EHS100 R-211623
Risk Category: 3
Food Establishment Inspection Report Paget of 2
Establishment type: ani0 Temporary Mobile Other
Date: t9/.?;
Establishment a,/r m's Grdl
Address �� i✓ !em Uri. kml� 10V
�ou{� �ilYlt #rPurpose
D
ePH
of Pubk Heath
Time In ; 3 0 AM/ Time Out AMIPM
LHD stlA UM�Town/Ci
of Inspection: cg�_ Pre -op
Reinspection Other
Permit Holder Rub 14ri
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodbome illness or injury. Interventions are confrol measures to prevenf foodbome illness or injury.
Mark designated compliance status (IN, OUT, NIA, NIO) for each numbered item IN=in compliance OUT=not in compliance NIA --not applicable WO=not observed
P=Priority item Pf--Priority foundation item C=Core item V=violation type Mark in appropriate box for COS and/or R COS=corrected on -site during inspection R=repeat violation
IN
Supervision
v
cos
R
NIA Nro Protection from Contamination
v
cos
R
Person/Altemele Person in charge present,
knowledge and performs duties
A(:�,3.
Pf
C
O
O
rD
��
15�-
O Food se arated and rotected P/C
O Food -contact surfaces: cleaned& sanitized PiPf
Proper disposition of returned, previously P
served, reconditioned. and unsafe food
O
Odemonstrates
17
JINOUT
O
O2
�yCertified
7
Food Protection Manager for Classes 2,
& 4
O
CD
Employee Health _
Management, food employee and conditional employee;
3 CDknowledge, responsibilities and re rlin P/Pf CDr1
TlmefTemperature Control for safe
18
O
O
O
Proper cookingtime and temperatures P/Pf/C
O
O
19
O
Proper reheatingprocedures for hot holdingP
O
O
4
O Proper use of restriction and exclusion
Written procedures for responding to vomiting and
O diarrheal events
P
C)
O
20
O
Proper coolingtime and temperatures
P
O
O
Pf
0
`�
21
O
Pro f hot holdin tern eratures
P
O
O5
22
I
O
Pro er cold holdin temperatures
P
O
Ofood
H ienic Practices
23
O
Pro er date markin and dis osition t 1pf
O
Os
O c Fr r eating lasting_drink..ing, or tobacco roducts use PIC
charge from s, nose, and mouth C
Preventing Contamination by Hands
O
O
C
24CDOland
Time as a public health control: procedures
records PIPE/C
O
O
O
Consumer Advlso
8
CDQ
clean and properly washed P/Pf O U
No bare hand contact with RTE food or a
pre -approved alternative pratedurepro perly followed P/PfIC O C)
Adequate handwashing sinks, properly suppliedlaceesslble IPf1C O U
Approved Source
25 C:)Consumer advisory provided: raw/undercooked food Pf O O
9Hands
�;(cD:)
0 0
Highly Susceptible Population
Pasteur¢ed foods used; prohibited foods not offered
10
Food/Color Additives and Toxic Substances
27 JCD
I O
I C6
= Food additives: ap proved and property used
P O
O
11
12
C)
O
CD
Food obtained from approved source L/PVC
Food received at proper ternrater$ P/Pf
O
O
V
C7
28 o
O
O
Toxic substances properly identified, PJPVC.
stored & used
O
O
13
O
IIIIIIIIIIIIINFood
in good condition, safe, and unadulterated
P/Pf
O
a
Conformance with Approved Procedures
14
CD
96C- Required records available: molluscan shellfish
ldentificatlort, parasite destruction
P/pf/C
CD
2g O O
Compliance with variance/specialized p/pf/C
rocess/RCP criteria/HACCP Plan
O
O
GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods.
Mark OUT if numbered item is not in compliance V=violation type Mark in appropriate box for COS and/or R COS=corrected on -site during inspection R=repeat violation
a NIA Nfo Safe Food and Water
v
cos
R
UT
Procter Use of Utensils
v
Cos
R
30
31
C) Pasteurized s used where required
O Water and ice from approved source
P
P/Pf/C
O
O
O
O_
43
e utensils: rn ri stored
C
O
O
44
silslequipmentilinens: properly stored, dried, & handled
Pf/C
O
O
32
O Variance obtained fors cialized rocessin methods
Pf
O
O
45
e-uselsingle-service articles: er stored & used
P/C
O
O
Food Tem rature Control
46
used property
C
O
G
33
34
Proper holing methods used; adequate equipment for
temperature control/COO
Plant food properly cooked for hot holdingPf
Zc)
Utensils and Equipment
47
O Food
prop
and non-food contact surfaces cleanable, p/pf/C
rl deli ned, constructed, and used
O
O
O
O
35
Approved thawing methods used
IRK
O
O_
48
Warewashing
O cleaningagents,
facilities: installed, maintained and used;
san[tizers, and test ships available/C
O
O
36
Thermometers rovided and accurate
Pf/COO
Food Identification
49
(::)[Non-food
Contact surfaces clean C
O
r
37 O Food property labeled; original container Pf/C •O O
Physical Facilities
Prevention of Food Contamination
38 O Insects, rodents, and animals not present Pf/C O O
50
O Hai
and cold water available; ad2guate pressure
Pf O
O
51
O Piumbing
installed; proper backffaw devices
P/Pf/C
v
t�
38
O
I Contamination prevented during food, r aratien, siorar ee & di y P/Pf/C
O
CD52
CDSewage
and waste water ry ff disposed
PIPE/C
O
C)
40kI:D
Personal cleanliness
Pf/C
O
O_
53
O Tollet
facilities: property constructed, supIEed, & clean Pf/C
p
O
Al
Wipf cloths: Ip rl used and stored C
fruits and vegetable P/Pf/C
O
O
O
ar??age and refuse pro rty disposed; facilities maintained
C O
O42Washin
O
O
Ph
ical facilities installed, maintained, and clean P1Pf
Q
O
Permit Holder shall notify customers t cap f t ost recent inspection report Is available.
56
Ad
. uale ventilation and lighting; designated areas used IC
O
O
Natural
rubber latex gloves not used per CGS 19a-36f
Person in Charge Si nature Date
Violations documented
I Dale corrections dire
#
Priority Item Violations
^
Person in Cha Printed
Priori Foundation ItemViolations
Core Item Violations
Ins for Si nature) Date j113d,/,23-
Risk Factork Violations
Health IHealth
Facs Iratetion
Repeat Risk FastoNPubilc Health fntervantivn Visiletivns
�I _ � A
Ins ctor Printed P�w zf ' 40&0
Good Retail Practices Violations
Reg ulres Rejinp ectivn - check box i( you Intend to reinspect
Appeal: The owner or operator of a food e0ablishment aggrieved by this order to correct any inspection violation identified by the food inspector or to hold, destroy,
or dispose of unsafe food, may appeal such order to the Director of Health, not later than forty-eight hours after issuance of such order.
410 Capitol Avenue MS#11 FDP
1st - White: Health Department Hartford, CT 06134 2nd - Yellow: Owner/Operator/Person in Charge
Food Establishment Inspection Report Page ? of. ?.-
LHD SOA U" �Inspection Report Continuation Sheet Date I1/30/23
Establishment u'Lr�"ts Uri ll Town OA W
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OBSERVATIONS AND OO
Violations cited in this report must be corrected within the time frames below, or as stated in sections 8405.11 & 8-406-11 of tha inert �nrin.
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Person in Charge(Signature)_Date
Ins ector (Signature) Date
Distribution: 1 st - White - Health Department 2nd - Yellow - Owner/Operator/Person in Charge