Page 1 of 3

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 #   MM025  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  MOMENCE MEADOWS NURSING & REHABILITATION Address  500 S WALNUT
Owner or Operator   INFINITY HEALTHCARE 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
X
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
  
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
  
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
X
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
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   CHLORINE 100 ppm                   Dishwasher Temperature   3BAY 50PPM; 180F DISH MACHINE °F or label
Food Temperatures:   CHICKEN 140-200; SPINACH 150; SOUP 49*; HAMBURGER 0, 41; MILK 40
 
General Comments
HACCP: DISCUSSED PROPER COOLING METHODS FOR ALL POTENTIALLY HAZARDOUS FOODS.

*NOTE: NOTICED SEVERAL FLYS IN BUILDING AND DINING AREAS. PLEASE PROVIDE PROPER PEST CONTROL METHODS FOR ALL FLYING INSECTS.

NO FOLLOW UP REQUIRED. 
Report and Instructions Received By   JOHN OR ALICE /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/07/2012 Time In  10:20 AM Time Out  11:45 AM Sanitation Score  90 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  90  
 
Page 2 of 3

    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 #   MM025  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  MOMENCE MEADOWS NURSING & REHABILITATION Address  500 S WALNUT
Owner or Operator   INFINITY HEALTHCARE City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
*3  OBSERVED THE FOLLOWING POTENTIALLY HAZARDOUS FOODS TO BE HELD AT IMPROPER TEMPERATURES: 1) COOKED, COOLED BROCCOLI SOUP IN WALK IN COOLER AT 49F SINCE PM SHIFT. PROVIDE FOR ALL COLD POTENTIALLY HAZARDOUS FOODS TO BE HELD AT 41°F OR BELOW AT ALL TIMES EXCEPT DURING NECESSARY PERIODS OF PREPARATION. WHEN COOLING POTENTIALLY HAZARDOUS FOODS PLEASE FOLLOW PROPER COOLING METHODS: 1) SHALLOW PANS NO DEEPER THAN 2" 2) BRING TO 70F WITHIN THE FIRST 2 HOURS, 3) BRING TO 40F WITHIN 4 HOURS AFTER IT REACHES 70F. SOUP DISCARDED, SEE VOLUNTARY DESTRUCTION AGREEMENT. (750.120) IMMEDIATE/ONSITE
2  OBSERVED THE FOLLOWING FOOD PRODUCTS TO HAVE IMPROPER/NO LABELING INFORMATION: 1) LARGE POT OF BROCCOLI SOUP IN WALK IN COOLER. PROVIDE FOR ALL FOODS TO HAVE PROPER LABELING INFORMATION. ALL PREVIOUSLY COOKED THEN COOLED FOODS MUST BE LABELED WITH ITEM NAME, TIME COOLING BEGAN AND USE BY DATE. SOUP DISCARDED. (750.100) NEXT INSPECTION
15  OBSERVED THE FOLLOWING IMPROPER NON-FOOD CONTACT SURFACES: 1) RACK PEELING IN CORNER BY FRONT SERVING AREA, 2) RUST ON LOWER CART IN MECHANICAL DISH WASHING AREA, 3) RUST ON RACKS IN CORNER IN 3-BAY AREA, 4) RUST ON RACKS IN HALLWAY BY BACK DOOR, 5) RUST ON RACKS IN DRY STORAGE WHERE CANNED GOODS ARE KEPT, 6) RUST ON RACKS IN MOP SINK ROOM. PROVIDE FOR ALL FOOD CONTACT SURFACES TO BE SMOOTH, EASILY CLEANABLE, NON-ABSORBANT, CORROSIVE RESISTANT, AND LIGHT COLORED. (750.690) NEXT INSPECTION
23  OBSERVED THE FOLLOWING CONTACT SURFACES TO BE UNCLEAN: 1) SHELVES IN FRONT SERVING AREA, 2) TRAYS W/CLEAN DISHWARE IN FRONT SERVING AREA, 3) WHITE FAN IN MECHANICAL DISH WASHING AREA. CLEAN AND MAINTAIN. (750.800) NEXT INSPECTION
37  OBSEVED THE FOLLOWING WALL/CEILINGS, AND ATTACHED EQUIPMENT TO BE UNCLEAN: 1) CEILING VENT IN MOP SINK ROOM. PROVIDE FOR ALL WALLS, CEILINGS, AND ATTACHED EQUIPMENT TO BE IN A CLEAN CONDITION. (750.1220) NEXT INSPECTION
42  OBSERVED THE FOLLOWING CLEANING EQUIPMENT TO BE IMPROPERLY STORED: 1) MOP LYING IN MOP SINK. CLEAN, SANITIZE AND HANG MOP TO DRY AFTER EVERY USE. (750.1390) NEXT INSPECTION
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   JOHN OR ALICE /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/07/2012 Time In  10:20 AM Time Out  11:45 AM Sanitation Score  90 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  90  
 
Page 3 of 3

    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 #   MM025  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  MOMENCE MEADOWS NURSING & REHABILITATION Address  500 S WALNUT
Owner or Operator   INFINITY HEALTHCARE City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
     
     
     
Report and Instructions Received By   JOHN OR ALICE /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/07/2012 Time In  10:20 AM Time Out  11:45 AM Sanitation Score  90 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  90