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
  
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
  
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
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   CHLORINE 100 ppm                   Dishwasher Temperature   180F *SEE LABEL ON REPORT IN FILE °F or label
Food Temperatures:   POTATOES 188; MIXED VEGETABLES 177; HAM 40; HAMBURGER 0, 39; MILK 40
 
General Comments
HACCP: DISCUSSED KEEPING FOOD WHOLESOME - NO DENTED CANS.

NO FOLLOW UP REQUIRED. 
Report and Instructions Received By   JOHN CLAYTON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/27/2013 Time In  10:00 AM Time Out  11:15 AM Sanitation Score  96 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  96  
 
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
15  OBSERVED THE FOLLOWING IMPROPER NON-FOOD CONTACT SURFACES: 1) RUST ON LOWER RACKS OF TABLE IN CORNER AT FRONT SERVING LINE, 2) RUST ON LOWER SHELVING OF FRONT COUNTER, 3) RUST ON WIRE RACKS IN CORNER OF 3-BAY SINK AREA, 4) RUST ON LOWER SHELF OF TABLE IN CORNER IN MECHANICAL DISH WASHING AREA, 5) RUST ON WIRE RACKS IN MOP SINK ROOM, 6) RUST ON WIRE RACKS IN DRY STORAGE - CAN AREA STORAGE, 7) CARDBOARD USED TO LINE WIRE RACKS ACROSS FROM MILK COOLER IN DRY STORAGE. 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) INSIDE OF CABINET NEXT TO OVENS, 2) HANDLES TO PUSH CARTS, 3) MICROWAVE OVEN. CLEAN. (750.800) NEXT INSPECTION
36  OBSERVED THE FOLLOWING FLOOR AREAS TO BE IN POOR REPAIR: 1) UNSEALED CONCRETE FLOOR IN MOP SINK ROOM. PROVIDE FOR ALL FLOORING AREAS TO BE SMOOTH, EASILY CLEANABLE, NON-ABSORBENT, DURABLE SURFACES, AND BE MAINTAINED IN GOOD REPAIR. RESEAL. (750.1200) OBSERVED THE FOLLOWING FLOOR AREAS TO BE UNCLEAN: 1) BEHIND/ALONG SIDES OF STOVES, 2) BEHIND 3-BAY SINK ALONG WALL. PROVIDE FOR ALL FLOORING AREAS TO BE IN A CLEAN CONDITION. (750.1220) NEXT INSPECTION
37  OBSERVED THE FOLLOWING WALL/CEILINGS, AND ATTACHED EQUIPMENT TO BE UNCLEAN: 1) WALL LEFT OF OVENS, 2) WALL ALONG/BEHIND/ABOVE 3-BAY SINK, 3) AIR CURTAIN FRONT OF BACK DOOR. PROVIDE FOR ALL WALLS, CEILINGS, AND ATTACHED EQUIPMENT TO BE IN A CLEAN CONDITION. (750.1220) OBSERVED THE FOLLOWING WALL/CEILINGS AREA(S) TO BE IN POOR REPAIR: 1) STAINED CEILING TILE IN DRY STORAGE ROOM. PROVIDE FOR ALL WALLS AND CEILINGS TO BE SMOOTH, EASILY CLEANABLE, NON-ABSORBENT, DURABLE, AND LIGHT COLORED AND BE MAINTAINED IN GOOD REPAIR. (750.1210) NEXT INSPECTION
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   JOHN CLAYTON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/27/2013 Time In  10:00 AM Time Out  11:15 AM Sanitation Score  96 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  96  
 
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 CLAYTON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  08/27/2013 Time In  10:00 AM Time Out  11:15 AM Sanitation Score  96 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  96