Food Establishment Inspection Report
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KANKAKEE COUNTY HEALTH DEPARTMENT
 2390 W. Station Street
Kankakee, IL 60901
Phone: (815) 802 - 9410
Establishment
 GOOD SHEPHERD MANOR 		License/Permit #
 MM012
Street Address
4129 N RT. 1 & 17 PO BOX 260
City/State
 MOMENCE, IL 		ZIP Code
 60954
No. of Risk Factor/Intervention Violations 0
No. of Repeat Risk Factor/Intervention Violations 0
Date 03/27/2025
Time In 09:50 AM
Time Out 10:50 AM
Permit Holder
GOOD SHEPHERD MANOR, INC. 		Risk Category
H
Purpose of Inspection
ORIGINAL INSPECTION

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item
IN=in compliance    OUT=not in compliance    N/O=not observed    N/A=not applicable
Mark "X" in appropriate box for COS and/or R
COS=corrected on-site during inspection    R=repeat violation 		Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury.
Compliance Status
 COS R

SUPERVISION

 
1 IN OUT N/A   Person in charge present, demonstrates knowledge, and performs duties    
2 IN OUT N/A   Certified Food Protection Manager (CFPM)    

EMPLOYEE HEALTH

 
3 IN OUT     Management, food employee and conditional employee; knowledge, responsibilities and reporting    
4 IN OUT     Proper use of restriction and exclusion    
5 IN OUT     Procedures for responding to vomiting and diarrheal events    

GOOD HYGIENIC PRACTICES

 
6 IN OUT   N/O Proper eating, tasting, drinking, or tobacco use    
7 IN OUT   N/O No discharge from eyes, nose, and mouth    

PREVENTING CONTAMINATION BY HANDS

 
8 IN OUT   N/O Hands clean & properly washed    
9 IN OUT N/A N/O No bare hand contact with RTE food or a pre-approved alternative procedure properly allowed    
10 IN OUT     Adequate handwashing sinks properly supplied and accessible    

APPROVED SOURCE

 
11 IN OUT     Food obtained from approved source    
12 IN OUT N/A N/O Food received at proper temperature    
13 IN OUT     Food in good condition, safe, & unadulterated    
14 IN OUT N/A N/O Required records available: molluscan shellfish identification, and parasite destruction    
Compliance Status
 COS R

PROTECTION FROM CONTAMINATION

 
15 IN OUT N/A N/O Food separated and protected    
16 IN OUT N/A   Food-contact surfaces: cleaned & sanitized    
17 IN OUT     Proper disposition of returned, previously served, reconditioned & unsafe food    

TIME/TEMPERATURE CONTROL FOR SAFETY

 
18 IN OUT N/A N/O Proper cooking time & temperatures    
19 IN OUT N/A N/O Proper reheating procedures for hot holding    
20 IN OUT N/A N/O Proper cooling time and temperature    
21 IN OUT N/A N/O Proper hot holding temperatures    
22 IN OUT N/A N/O Proper cold holding temperatures    
23 IN OUT N/A N/O Proper date marking and disposition    
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records    

CONSUMER ADVISORY

 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food    

HIGHLY SUSCEPTIBLE POPULATIONS

 
26 IN OUT N/A   Pasteurized foods used; prohibited foods not offered    

FOOD/COLOR ADDITIVES AND TOXIC SUBSTANCES

 
27 IN OUT N/A   Food additives: approved and properly used    
28 IN OUT N/A   Toxic substances properly identified, stored, & used    

CONFORMANCE WITH APPROVED PROCEDURES

 
29 IN OUT N/A   Compliance with variance/specialized process/HACCP    

GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods.
Mark "X" in appropriate box for COS and/or R      
COS
=corrected on site during inspection  
R
=repeat violation  
Compliance Status
 COS R

SAFE FOOD AND WATER

 
30   Pasteurized eggs used where required    
31   Water & ice from approved source    
32   Variance obtained for specialized processing methods    

FOOD TEMPERATURE CONTROL

 
33   Proper cooling methods used; adequate equipment for temperature control    
34   Plant food properly cooked for hot holding    
35   Approved thawing methods used    
36   Thermometers provided & accurate    

FOOD IDENTIFICATION

 
37   Food properly labeled; original container    

PREVENTION OF FOOD CONTAMINATION

 
38   Insects, rodents, & animals not present    
39   Contamination prevented during food preparation, storage & display    
40   Personal cleanliness    
41   Wiping cloths: properly used & stored    
42   Washing fruit, vegetables and other plant food    

PROPER USE OF UTENSILS

 
43   In-use utensils: properly stored    
Compliance Status
 COS R

PROPER USE OF UTENSILS

 
44   Utensils, equipment & linens: properly stored, dried, & handled    
45 X Single-use/single-service articles: properly stored & used    
46   Gloves used properly    

UTENSILS, EQUIPMENT, AND VENDING

 
47   Food & non-food contact surfaces cleanable, properly designed, constructed & used    
48 X Warewashing facilities: installed, maintained & used; test strips X  
49   Non-food contact surfaces clean    

PHYSICAL FACILITIES

 
50   Hot & cold water available; adequate pressure    
51   Plumbing installed; proper backflow devices    
52   Sewage & waste water properly disposed    
53   Toilet facilities: properly constructed, supplied, & cleaned    
54   Garbage & refuse properly disposed; facilities maintained    
55 X Physical facilities installed, maintained & clean    
56   Adequate ventilation & lighting; designated areas used    

FOOD HANDLER AND ALLERGEN AWARENESS

 
57   Food handler training 410 ILCS 625/3.06.    
58   Allergen awareness training for CFPM 410 ILCS 625/3.07 (rest. only)    
59   Allergen awareness notice 410 ILCS 625/3.08 (rest. only)    
Food Establishment Inspection Report
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Establishment: GOOD SHEPHERD MANOR Establishment #: MM012
Water Supply:   Public Private   Waste Water System:   Public Private
Sanitizer Type: Chemical PPM: CHLORINE 100 Heat: 180 °F
IL Requirements: Use of non-latex gloves for food handling and preparation 410 ILCS 180/10 - YES
  Appropriate default beverage for children's meal 410 ILCS 620/21.5 - N/A
CFPM Verification (name, ID#, expiration date):
TARASHA AVANT
22432106
07/20/2027 		CRYSTAL ROSE
23767083
03/25/2028 		MELISSA BOICE
21893658
11/19/2027 		RACHEL WEBB
24456572
08/26/2028

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
corn/serving hot hold 152.00°F meat dish/serving hot hold 167.00°F popsicle /reach in freezer 0.00°F
apple juice/reach in cooler 40.00°F green beans/reach in freezer 0.00°F tuna/walk-in cooler 40.00°F
Brussel sprouts/walk-in freezer 0.00°F egg omlets/reach in freezer storage room 0.00°F  

OBSERVATIONS AND CORRECTIVE ACTIONS
Item
Number 		Severity Violations cited in this report must be corrected within the time frames below.
45 C 4-903.11( A)(1)(2)(3): (A) Except as specified in ΒΆ (D) of this section, cleaned EQUIPMENT and UTENSILS, laundered LINENS, and SINGLE-SERVICE and SINGLE-USE ARTICLES shall be stored: (1) In a clean, dry location; (2) Where they are not exposed to splash, dust, or other contamination; and (3) At least 15 cm (6 inches) above the floor.
Observed some boxes of single use food equipment stored on the floor in the food storage room. Provide for all food and equipment be stored off the floor. Correct and maintain by next routine inspection.
48 PF 4-303.11(B): (B) Except for those that are generated on-site at the time of use, chemical SANITIZERS that are used to sanitize EQUIPMENT and UTENSILS as specified under Part 4-7, shall be provided and available for use during all hours of operation.
Observed no sanitizer solution set up at the time of my inspection. Sanitizer solution should be available to clean and sanitize any potential mess or spill. Sanitizer was set up. COS
55 C 6-501.12: (A)PHYSICAL FACILITIES shall be cleaned as often as necessary to keep them clean.(B)Except for cleaning that is necessary due to a spill or other accident, cleaning shall be done during periods when the least amount of FOOD is exposed such as after closing.
Observed the floor under the shelves in the was in freezer to be in need of cleaning. Clean and maintain by next routine inspection.
Inspection Comments   FACILITY IS COVERED WITH CFPM LICENSES FOR THIS INSPECTION.
HACCP Topic: PROPER SET UP OF A SANITIZER BUCKET.
 

Person In Charge:

  CRYSTAL ROSE 		 

Date:

  03/27/2025
 

Inspector:

  Angela Colon 		 

Follow-up:  Yes   No   Follow-up Date: