HomeMy WebLinkAbout2023-8-30 - 1000 Evergreen Way - Food Inspection ReportConnecticut Department of Public Health EHS-1G8 R—M623
Risk Category: 4
Food Establishment Inspection Report Pagel of 2
Establishment type: fqrmanen Temporary Mobile Other
Date: 0/30/,23
Establishment (�"u
DPH
00
`d""`
Time Out (2'. -90 AM/
Time In 8 2�J.
_
Address 10" Ev& re l V��
Town/City �KKn Lirvlhof
Permit Holder�y �{
LHD SC Afc UvIA ' ,�PM
Purpose of Inspection: Qouttne Pre -op
Reins ection Other
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Risk factors are important practices or procedures identired as the most prevalent contributing factors of foodbome illness or injury. Interventions are control measures to prevent foodbore illness or injury.
Mark designated compliance status (IN, OUT, N/A, N/O) for each numbered item IN=in compliance OUT=not in compliance N/A=not applicable NIO=not observed
P=Priority item Pf=Priority foundation item C=Care item V=violation type Mark in appropriate box for COS and/or R COS=corrected on -site during inspection R=repeat violation
IN
OUT
Supervision
vCosi
R
CDO
IN
GUT
N/A NIC Protection from Contamination
v
COS
R
O
INIA
Person/Alternate Person in charge present,
demonstrates knowledge and performs duties
PF
15
7O
O CD.Food se arated and protected
P/C
CD
O1
16
C)C)Food-contact
surfaces: cleaned & sanitized P1PfIC
CD
C)2
SU3,
O
Certifier} Food Protection Manager for Classes 2,
& 4
C
O O
17
�
O
Proper disposition of returned, previously
served, reconditioned, and unsafe food
P
CD,_3
Employee Health
gement, food employee and conditional employee;
3 O1[n_pwrespynsibilibesladand_repvrtfn PIPE O O
4 Oer use of mil"Ic'tion and exclusion P O O
TlmalTem erature Control for 50sty
16
O
O
O
Proper cookie time and temperatures P1PfIC
O
O
19
O
O
�,
Proper reheatingprocedures for hot haldln
P
O
O
20
Ce
O
C�
c3
Prq r cooli time and teal aratufes
P
O
O5
m
Oen procedures for responding to vomiting and
events
PF
O
O21
O
C)
G
Pro er hot holdin tem erature&
P
O
Oheal
22
O
O
Cj
Proper cold holdiq tem eratures
P
O
O
Good HyglapfC Practices
23 CD C Proper date mlrklng and dis ositl.on I P/Pf O O
Time as a public health control: procedures
24 rD O P/Pf/C O O
and records
Consumer Advisory
25 RA O CDOaneumer advisory provided raw/undercooked food Pf O rcp
Hight Susceptible Population
_
6
7
O
a O
Proper eating, tasting, drinking, or tobacco roducta use
O No discharge from eyes, nose, and mouth
P/C
O
O
C
OVp
Preventin Cotttamination by Hands
8
9�4
_
10
O O
0 CD
O
Hands cleawand property washed I P/PF
No bare hand contact with RTE food or a
P/PfIC
pre-aalternative procedure property followed
Adequate handwashirlg sinks, prop rly tiupplledlaCCessigl0 Pvc
O
I O
O
O
26 �$ O :� Pc3staurixnd foods used; prnhihi!¢ci foods not offered
Food/Color Additives and Toxic Substances
CD
O
Approved Source
27
G.
O
Food additives: approved and proad used P
O
CD
11
C:)Food
obtained from approved source PIPfIC
Q Food received at prober tem erature PIPE
Food in good condition, safe, and unadulterated PIPf
Required records available: molluscan shellfish pIPfIC
identlfiratio n, parasite destruction
O
O
28
O
O
Toxic substances properly identified,
stored & used PIPE/C
CD
CD
12
13
14
Q
O
O
O
O
O
O
O
O
O
O
Conformance with Aroved Pfocadures
29 Gi O Compliance with variancelspecialIzed p/pf/C O C
rocess/ROP criteria/HACCP Plan
GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition ofpathogens, chemicals, and physical ob'ects 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
Safe Food and Water
vcos
R
OUT
Pro er Use of Utensils
v
COSR30
AWA
Pasteurized s used where re ulretJ
Water and ice from approved source
i18r€ttflpa obtained fors eefa}ited racessin inethgdS
P
O
O
43
O In
-use utensils: ro erl stored
C
O
Oq1
P/PfIC
O
O
Utensils/e
uipmenUlinens: properly stored, dried, & handled
Pr
O
O32
Pf
O
O_
45
Sin
le-use/sin le -service articles: roper) stored & used
P/C
O
O
Food Tom rature Control
46
O Gloves
used properly
C
O
O
33
Proper cooling methods used; adequate equipment for
temperature control
Pf/C
_
O
O
O
O
Utensils and Equipment
47
Food
raped
and non-food contact surfaces cleanable,
designed, constructed, and used PIPfIC
O
O
34
Q C� Plant food rvperl cooked for hot holdingPf
j(D
35
G O A roved thawing methods used
Themwmeters provided and accurate
Pf/C
O
O
48
O Warewashing
cleaning
facilities: installed, maintained and used;pflC
agents, sanitizers, and test strips available
O
O36
Pf/C
O
O
Food Identification
49
O Non-food
contact surfaces clean C
O
O
37 O Food)roperly labeled; original container I PfIC I CD O
Physlical Facilities
Prevention of Food Contamination
50
O Hot
and cold water available; adequate pressure Pf
O
O
O
Insects, rodents, and animals not present PfIC
O
O
51
O[Plumbing
installed; proper backflow devices P/Pf/C
O
O
Contamination prevented during food preparation, storage & display P/Pr!
O
52
O Sewa
a and waste water properly disposed PIPrlC
O
O
_
4t}
O
Personal cleanliness
PfIC
O
O
53
O Toilet
facilities: properly constructed, supplied, & clean Pf/C
O
O
41
O
Wlpin� cloths: proper4 used and stored
C
O
O
54
O Garbage
and refuse properdisposed: facilities maintained C
O
O
42
O
Washin fruits and ve etables P/PrIC
O
O
UY
Physical
facilities installed, maintained, and clean P/Pf
(D111
O
Permit Holder shall notify customers that y the most recent inspection report is available.
56
CD Adequate
ventilation and lighting; designated areas used C
O
O
O Natural
rut)ber late% gloves not used per CGS 19a-36f
�—
Person in Charge SI nature Date 6Z
Violatlons
documented
Date corrections due
#
Priority Item Violations
kz
Person in Charge (Printed) f
_
Z
Priority Foundation Item Violations
Core Item Violatfons
Ins tar Si nature Date 3d�
Risk FactoriPublic Health Intervention Violations
Repeal Risk Factor/PubliC Health Intervention Violations
Good Retail Practices Violations
I n spector Printed +: h o
Requires Reins 'tat - Check box ff you intend to reinspect
L
Appeal: The owner or operator of a food establishment 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 fart"ight hours after issuance of such order.
410 Capitol Avenue MS#11 FDP
1 st -White: Health Department Hartford, CT 06134 2nd - Yellow: Owner/Operator/Person in Charge
Food Establishment Inspection Report Page 2 of 2
LHD StnA+� UMhILV- Inspection Report Continuation Sheet
, , ^ Date V 30%3
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TEMPERATURE OBSERVATIONS
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OBSERVATIONS AND CORRECTIVE ACTIONS
Violatlons cited in this report must be corrected within themeframes 6efow, or as stated in sections 8-4 5.11 & 8406-11
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Person in Charge [Signature] _ Date _
Inspector Si nature Date
Distribution: 1st - White - Health Department 2nd - Yellow - Owner/Operator/Person in Charge