Page 1 of 2

X Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM049  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  THOMAS LOMBARD HOUSE Address  4129 A N. RTS. 1/17
Owner or Operator   GOOD SHEPHERD MANOR GROUP HOMES, INC. City   MOMENCE Zip Code   60954
 
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
 
FOOD
18
 
1
 Pre-flushed, scraped, soaked
34
  
1
 Outside storage area, enclosures properly constructed, clean: controlled incineration
*1
  
5
 Source, Wholesome, No Spoilage
19
  
2
 Wash, rinse after: clean, proper temperature
2
X
1
 Original Container, Properly Labeled
*20
  
4
 Sanitization rinse: Clean, temperature, concentration   INSECT, RODENT ANIMAL CONTROL
 
FOOD PROTECTION
*35
  
4
 Presence of insects/rodents - outer openings protected; no birds, turtles, or other animals
*3
  
5
 Potentially hazardous food meets temperature requirements during storage, preparation, display, service and transportation
21
  
1
 Wiping cloths: clean, use restricted
22
  
2
 Food contact surfaces of equipment and utensils clean, free of abrasives and detergents  
FLOORS WALLS AND CEILINGS
36
X
1
 Floor: constructed, drained, clean, good repair, covering installation, dustless cleaning methods
*4
  
4
 Facilities to maintain product temperature
23
X
1
 Non-food contact surfaces of equipment and utensils clean
5
 
1
 Thermometers provided and conspicuous
37
X
1
 Walls, ceiling, attached equipment: constructed good repair, clean surfaces, dustless cleaning methods
6
 
2
 Potentially hazardous food properly thawed
24
  
1
 Storage, handling of clean equipment utensils
*7
  
4
 Unwrapped and potentially hazardous food not re-served, Cross Contamination
25
  
1
 Single-service articles, storage, dispensing  
LIGHTING
26
  
2
 No re-use of single-service articles
38
  
1
 Lighting provided as required - Fixtures shielded
8
X
2
 Food protection during storage, preparation, display, service and transportation  
WATER
  
VENTILATION
*27
 
5
 Water source, safe: Hot and cold under pressure
39
  
1
 Rooms and equipment - vented as required
9
  
2
 Handling of food(ice) minimized, methods  
SEWAGE
  
DRESSING ROOMS
10
  
1
 Food(ice) dispensing utensils properly stored
*28
  
4
 Sewage and waste water disposal
40
  
1
 Rooms clean, lockers provided, facilities clean
 
PERSONNEL
  
PLUMBING
  
OTHER OPERATIONS
*11
  
5
 Personnel with infections restricted
29
  
1
 Installed, maintained
*41
  
5
 Toxic items properly stored, labeled and used
*12
  
5
 Hands washed and clean, good hygienic practices
*30
 
5
 Cross-connection, back siphonage-backflow
42
  
1
 Premises: maintained, free of litter, unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel
13
  
1
Clean clothes, hair restraints
  
TOILET AND HAND-WASHING FACILITIES
 
FOOD EQUIPMENT AND UTENSILS
14
  
2
 Food (ice) contact surfaces: designed, constructed, maintained, installed, located
*31
  
4
 Number, convenient, accessible, designed, installed
43
  
1
 Complete separation from living/sleeping quarters, laundry
32
 
2
 Toilet rooms enclosed, self-closing doors, fixtures, good repair, clean: Hand cleanser, sanitary towels/hand drying devices provided. Proper waste receptacles, tissue
15
X
1
 Non-food (ice) contact surfaces: designed, constructed, maintained, installed, located.
44
  
1
 Clean, soiled linen properly stored
 
CERTIFIED PERSONNEL
16
  
2
 Dishwashing facilities: designed, constructed, maintained, installed, located, operated
*45
     Management personnel certified Yes X No     Registered for class    
 
GARBAGE AND REFUSE DIPSOSAL
17
  
1
 Accurate thermometers, chemical test kits provided, gauge cook
33
X
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   chlorine ppm                   Dishwasher Temperature   180F See attached label on report on file °F or label
Food Temperatures:   eggs 37; ham 2; cheese 37; freezer 8; chicken 20
 
General Comments
Haccp: discussed keeping soap and paper towels at hand sink.

No follow up required. 
Report and Instructions Received By   Stephanie Gore /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  10/24/2006 Time In  10:00 AM Time Out  12:00 PM Sanitation Score  91 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  91  
 
Page 2 of 2

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM049  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  THOMAS LOMBARD HOUSE Address  4129 A N. RTS. 1/17
Owner or Operator   GOOD SHEPHERD MANOR GROUP HOMES, INC. City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
2  Observed raw chicken not labeled in upright freezer in store room. Once out of original container, please label w/date and name. (750.100) Immediate/Onsite
8  Observed food/dessert not covered in refrigerator. Please store protected during storage. (750.120) Immediate/Onsite
15  Observed shelving paper on bottom shelf of cabinet in between refrigerators. Please remove. (750.690) Immediate/Onsite
23  Observed the following non-food contact surfaces in need of cleaning: Please clean. (750.800) 1. inside freezer - one w/butter 2. all inside lower shelves of cabinets 3. outside of seasoning containers in cabinet 4. store room shelves 5. inside bottom shelf of upright freezer in storeroom Immediate/Onsite
33  Observed exterior of kitchen trash can in need of cleaning. Please clean. (750.1130) Immediate/Onsite
36  Observed floor in dry storage room in need of cleaning. Please clean. (750.1220) Immediate/Onsite
37  Observed ceiling vents in restroom in need of cleaning. Please clean. (750.1210) Immediate/Onsite
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   Stephanie Gore /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  10/24/2006 Time In  10:00 AM Time Out  12:00 PM Sanitation Score  91 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  91