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
X
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
  
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 Bleach 100-200 ppm                   Dishwasher Temperature   180F *see label on report in file °F or label
Food Temperatures:   spaghetti 152; pork chops 175; hamburger 5, 41; milk 38
 
General Comments
Conducted routine inspection and possible food borne illness outbreak due to apprx. 25 residents that have become ill. Nothing unusual found in dietary area. See note below.

Haccp: discussed keeping all food wholesome.

No follow up required.

Note: facility has bleach concentration too strong. Please make sure concentration does NOT go over 200 ppm. Bleach is toxic and can cause adverse health affects. 
Report and Instructions Received By   John Clayton /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  02/08/2011 Time In  9:45 AM Time Out  11:15 AM Sanitation Score  91 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  97  
 
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
*1  OBSERVED CANS OF BEST WISH SPAGHETTI SAUCE TO BE DENTED ON SEAMS. PLEASE PROVIDE FOR ALL FOOD TO BE WHOLESOME. CANS REMOVED FROM SHELVES. SEE VOLUNTARY DESTRUCTION AGREEMENT. IMMEDIATE/ONSITE
15  OBSERVED THE FOLLOWING NON-FOOD CONTACT SURFACES TO BE IMPROPER: 1. RUST ON RACKS IN FRONT BY STEAM TABLE, 2. RUST ON RACKS THAT HOLD THE CLEAN PANS ACROSS FROM 3-BAY SINK, 3. RUST ON RACKS IN WALK IN COOLER, 4. RUST ON RACKS IN DRY STORAGE ROOM WHERE SINGLE SERVICE AND CANNED GOODS ARE KEPT, 5. RUST ON RACKS WHERE CHEMICALS ARE KEPT IN UTILITY CLOSET. REPAIR, REPAINT OR REPLACE. (750.690) NEXT INSPECTION
23  OBSERVED THE FOLLOWING NON-FOOD CONTACT SURFACES IN NEED OF CLEANING: 1. FRONT SHELVES BY STEAM TABLE, 2. SINGLE SERVICE HOLDERS ON BEVERAGE CARTS. PLEASE CLEAN. (750.800) NEXT INSPECTION
37  OBSERVED PAINT CHIPPING ON GREY CART IN MECHANICAL DISH WASHING AREA. PLEASE REPAIR. (750.1210) OBSERVED THE FOLLOWING IN NEED OF CLEANING: 1. HOOD FILTERS OVER STOVE, 2. CEILING VENT IN KITCHEN ABOVE PREP TABLES, 3. CEILING VENT IN LADIES RESTROOM - C/D HALL. PLEASE CLEAN. (750.1220) NEXT INSPECTION
42  OBSERVED EMPLOYEE PERSONAL BELONGINGS ON CLEAN DISH CART THAT HOLDS BOWLS IN MECHANICAL DISH WASHING AREA. PLEASE KEEP ALL PERSONAL BELONGINGS COMPLETELY SEPARATE FROM KITCHEN. ITEMS REMOVED. (750.1350) IMMEDIATE/ONSITE
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   John Clayton /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  02/08/2011 Time In  9:45 AM Time Out  11:15 AM Sanitation Score  91 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  97  
 
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  02/08/2011 Time In  9:45 AM Time Out  11:15 AM Sanitation Score  91 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  97