Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Cold Spring in: 10:00 low: I 15.24.19 Foodhorne illnet-t- risk factors are important practices or procedures address: 25 Alden St Inspection by: Marcia Lee I Identi?ed as the most prevalent contributing factors of foodborne Phone: 508 330.4335 51' nature: illness and/or injury. Public health interventions are control measures Last lnsp. Date: unknown Received by: Christine Morgan used to prevent such food borne illness andfor mjunr, Purpose of Impectlon: routine Signature: Types e'i Inspection: Routine, Re?Inspection, HACCP, Pre?Operation, Type of Establishment: elementary school Email: Susoect Illness, Complaint, or Other UcenseJ'Permlt Number: 23,482,349 lBusiness Email: SOURCE OF FOOD Points IN out rule cos Code COMMENTS Approved source for food, water,and ice; received at proper temperatures, wholesome, 1 nonadulterated, in good condition, records available. ?3?201.11, ?3?202 11, ?3?202 15 3 590 003W Items must be properly date marking dlspos?lon: date prepared, date frozen, date thawed, 2 expiration date. 53-50118. ?3-501.17 2 590 007 FOOD PROTECTION Points IN OUT NIO NIA ?05 I .Code COMMENTS Potentially hazardous food meets temperature requirements storage, PfBPafaBOni 3 3 bag salad being transported from PCIS is with tia':sac':eo '1 a "in crate wizr- no ice or method to service. and transportation ?3?401 11' gr} 590 ?03 keep it told that temperature of the product was 63 5 upon arrival The kitchen PIC put it into cold 3 storage to ma a ti ch.. 4 pf Adequate facilities to maintain product temperature, thermometers provided 1 I 4 590 004 5 Thorn-omelet: are maul. oompmoueiy pieced accurate, cal-armed, present 1 5 590 003 5 pf Potentially hazardous food properly thawed 2 5 3 Proper disposition of returned, previouer served, reconditioned, and unsafe food ?3?306 14, 2 7 590 003 3 p?pflc Food protected during storage, preparation, display, service 5 transportation Food 3 containers stored off ?oor Washing fruits and vegetables ?3-302 11, ?3-304.11, 304 15IA). 3 590 on; 9 plpf; No bare hand contact with ready-to-eat foods, proper utensils used, or approved alternate 9 method properly followad ?3-301 ?301 hygienic practices, proper handwashing and glove changing observed ?2-301 11, ?2-301 12, ?2-301 14 3 590 003m} In use food dispensing utensils properly stored 1 10 590 003 EMPLOYEE HEALTH Poin? IN OUT NIO NIA COS ITEM Code COMMENTS Management awareness; Proper use of reporting, proper exclusion for 11 reportable diseases. ?2?201 11, ?2?201 12, ?2~201 13 No discharge from eyes, nose, or 590 D02 Mouth observed. ?2-401.12 3 12 Proper eating, tasting, drinking Smoking restricted. ?2?401 11, ?3?301.12 12 set: 003 3 at Sec 002 Proper hair and beam are worn cone-city. clean uni orms_ ?c?n WHIEGS. rind 13 aprons, proper glove use 1 590 002 EQUIPMENT a UTENSILS: oesren.cousmucno~ 8. INSTALLATION point, m: code COMMENTS Food-contact surfaces constructed, maintained, Installed, located 2 14 599 any Nonfood~conlect surfaces designed, constructed, maintained, installed. located 1 15 590 007 Dishwashing facilities approved design, adequately constructed, maintained, installed, 16 located new machine the manufacturer plate says 160 wash 180 ?nal rinse. The wash cycle reads 160 the 2 590 004 rinse cycle gauge does not move however the Il-Ierma! strip demonstrating 150 at the plate 11 Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present 17 590 004 Tem-erature and psigauges are accurate. 4-501 113 1 Tablewares and Equipment is pre-?ushed, scraped, and soaked prior to cleaning 13 590 004 1 Wash and rinse water is clean, and at proper temperature 2 19 599 095 Sanitizatidn rinse (hot water? chemical) Proper sanitization offood contact surfaces through setup to: sanitizing {that] contact so: fan:-a We?re watt-twig 5 not set up according to temperature, chemical concentration, exposure time for equipment and utensils 54-501 111111M) ?use erEisa eys inka'tathed to the greasetrap thatpro hibbett we re watching,and 590 004 outdates to compartment sink Is used With a hose attached but does not come off for maintenance Must provide chemical or Santa sensation with test kit and log sheet for food contact services in the 20 3 20 ITEM Memoirs FROM CONTAMINATION Points IN OUT NID NIA COS ITE Code COM MENTS 21 Wiping cloths propeny stored clean and dry or in a sanitizing solution Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL INSPECTION FORM 22 Food-contact surfaces of utensils a equipment clean ?4?602 11 2 22 590 004 23 surfaces at utensils a equrpment clean 1 23 590 004 24 Proper equipmentr'utensils storage, handling, to prevent contamination 1 24 590 004 ITE PROTECTION FROM CONTAMINATION Points IN OUT NIO NIA COSI ITE Code COMMENTS 25 service articles are from an approved source, are stored, handled. dispensed, used 25 590 004 and disposed of in a manner that prevents contamination 1 25 No re?use of single service containers [or food or chemical storage 1 26 590 [:04 Photographs WATER SUPPLY 8 DISPOSAL Point: IN OUT NIB MIA (205' ITEM Code COMMENTS Water supply is from an approved source and water supply is suf?cient torthe operations inti. 3 27 590 005 Sewage disposal approved Proper disposal of waste water in approved disposalfacilities (ie 23 530 pos slop sinks) 3 Hour-nu IFLUMBING wr IN DUT NIB cos ITEM Code Location. installation. maintenance lie dripping faucet-e. leaking pipes improperly wasting 1 1 29 590 005 Insuf?cient warewash sink set up. No designated Handwash sinks. Only 2 hey sink no three bay sir Plumbing Installed protruding cross connection. back uphonpgo, backfimv. 2 30 590 005 31 Adaq?ats halldwaShillg facilities, 635"! accessible, designed, installed. ?5?202 12 31 590 005 r. on: handwashing faciltiies in the kitchen only one and It is a converted single bay sink set 3 3 nay mi cannot remove. Toilet facil ies: properly constructed, self closing doors, ?xtures in good repair, supplied with 32 soap and towels in dispensers! hand-drying devices, cleaned. covered sanitary dispoal recepti handwesh present Toilet facilities have self-closing doors and doors do 590 005 not open mic :Ireep whore load is exposed to airborne contamination and are adequately 590 pos separated from food processing and storage areas 2 We AND GROUNDS Points IN OUT NIO NIA COS ITE Code Suf?ceint covered trash receplicles present in adequate number, leak proof, insect/rodent 33 590 005 proof_ emptied with adequate frequency clean 2 3? Outside premises are free from trash, etc free of harborages, breeding places for rodents, 34 Insects. and other pests Outside areas (roads, yards, disposal systems) provide adequate 590 006 drainage and do not constitute a source of contamination. Controlled incineration 2 Doors, windows, and other openings are protected to eliminate entry by insects, 35 590 006 No evidence of pests present 3 Flutelraplr-r FLOORS, WALLS l- CEILINGS Point IN OUT NIA COS ITE Code COMMENTS 35 Proper floor construction, proper floor covering installed, ?oors graded with drained as 35 required, floor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 DOE morocco me no non-trod 1 1 ?oor In the storage area has paint. worn and needs to be rescaled. Walls, ceilings, attached equipment, properly constructed, good repair, clean Well a ceiling . . . . . . . . . 37 surfaces as required Dustless cleaning methods used as needed 1 1 37 590 one paint In the ceiling In the kItchen and on the ducts are blistered and peellng It needs to be scraped and resurfaced also on the wall by the dishwasher 33 Adequate lighting provided for suf?cient candle light Fixtures properly shielded or use of 38 590 005 shatter prood bulbs 1 it one cracked llaht shield obs awed one broken shield observed 39 Air quality and ventIlatIon are adequate to remove excessive heal for equipment and rooms 39 590 004 and prevent contamination by dust. andlor other airborne substances 1 the hood has not been Inspected and tagged 40 40 Locker rooms, employee changing areas, provided, located to prevent contamination of production areas, and used for storage of employee personal items properly equipped and 590 BM properly ventilated Dressing rooms are maintained in good physical repair, 1 41 41 Insecticides and rodentita'des are used and stored so as to prevent contamination of food items Detergents, sanitizers and other cleaning sup lies are used in a safe, e?edive ago no? manner Hazardous materials are kept in their original containers and stored separate from raw materials. ?7-202.12, ?7-203 11, ?7?1 D1 11, ?7?201 11 3 a 42 Premises maintained free of litter, unnecesary items and articles, cleaning maintenance 42 5 0 00 6 equipment properly stored 1 1 5 Separation of maintenance rooms and equipment, laundry facilities by partition 1 43 590 004 Sorted linens property stored 1 44 590 004 mm -?Phammaphs RESPONSIBLE PERSON tN canoe Pointsl IN NIO NIA lcos [comments 45 C?l?llrm Fm? Manager. ?2-1?2 120?) 3 I i 3 45 1590 00? [person out sick who is certilntd ru certi?es moment" 26 Court St. Plymouth, MA 02360 Tel: 508?747?1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM PIC is present, knowledgeable, understands sanitary controls, demonstrates 45 knowledge. performs duties. ?2-103.11 3 3 59?1?? ?5 Cath- Button-West is In. Is trying to but cannot answer PIC quetsions because has not had trainii HIGHLV SUSCEPTABLE POPULATIDNS Points IN OUT NIO COSI ITEM Code Pastuan'zed foods ueed; prohibited foods not offered ADDITIVES Points IN OUT NIO ITEM Code Food additiveszapproved and properly used ?3?202 12 2 I 48 590 003 EQUIPMENT AND UTENSILS Polnts 1N our "in NM cos ITEM Code COMMENTS All utensus and equrpment are cleaned and sanitized at Intervals that are lrequant enough to 49 .393 004 avoid mr?an'iinahon? of food rot-Jude. ?4-602.11 2 2 5? Instrumenls and controls used for measuring. regulating. or recording lemperalLre, pH. acidity. water 50 activity. or other conditions are accurate and adequame mairllained and calibrated 590 904 1 51 Molluskan Shaltfish Tanks maintained. tested. and logs kept 1 51 590 004 Prim-mm HEALTH PROCEDURES Pains IN OUT NIO NIA COS ITE Code COMMENTS Procedures for responding to vomiting diam-ml events. ?2-501 11 1 52 590 002 CONSUMER ADWSORY POSTED Points IN OUT Nlo cos ITEM Code COMMENTS Consumer Advisory Posted ?3-603. ll 1 I 53 set) 003 SPECIAL PROCESSES Point: IN OUT NIO NM COS ITEM Code Required records available; shellstock tags, parasite destruction,Time As a Public Health 54 590 on: Control, required Iogg ?3-203_12. $402.12.. ?3-202 18 3 In Compliance With $403.12. (53-302. I4 2 I 55 590 ml?! CONFORMANCE WITH APPROVED PROCEDURES Poln?m IN OUT NIO NIA COS ITEM Code COMMENTS I (?lie en Certificate . 590 011w No current can-hula Ann-Choking . 590 Elli No turlanl certified person 0.6. Local BCI-H Regulation it local Not following fog Firm is currently licensed by the regulatory authority havingjurisdiction it local RECORD CHECKLIST COMMENTS Water quality and supply records, grease trap cleaning record. ansul system cleaning records and ta 5 current Fire exti uisher ta 5 current Employee training records it Temperature control records Equipment monitoring and maintenance records Calibration records it Sanitation records Required Logs; Time as a Public Health Control, Receiving Temperature, parasite 590 008 as ru 0 Pest control records I Variance request and approval. Time as a Public Health Control Procedure 590 ooard) Inspection records (e . incoming product. facility. production area) it ITEMS OBSERVED IN: In CompIIance In Red Risk Factors Observed (Priority) pts. Deducted 9 OUT: Out of Compliance In Blue Good Retail Practices Observed (Priority Foundation. Core) pts. Deducted 13 Not Observed Total Non-Compliant Observations total points deducted 22 Not Applicable SCORE: 78 COS: Corrected on Sight 26 Court St Plymouth, MA 02360 Tel: 503-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD FORM Repeat Violation 'Vioiatlans cited must be corrected within the time frames in section 3405.11 or in dates othenuise written in the report. I . - OFFICIAL ORDER FDR CORRECHON: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation I 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct vioiations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10] calendar davs of receipt oi this order. Temperatures Taken: ADDITFONAL NOTES: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10113 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT are?i ?re LII Lea-:41 w- of Ins ection Routine Address Re-inspection Telephone Owner . to eration .- I Food Service . Risk II Retail I ?Ci Level Residential Kitchen Previous Inspection LI 9w Mobile Date: Temporary Pre-operation HACCP grim i Jig-ha rub-I Y, Caterer Suspect Illness Person in Charge PIC) EL Time Bed 8. Breakfast General Complaint I I Ui? (Inc-i In: HACCP nspector {f ?2"me? Out' PermitNo. EIOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non- -comph?ance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Ann.cnomng 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590-009 IF) action as determined by the Board of Health. ?9'39" ?wa'eness 590-009(6) FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. El 3. Personnel with Infections RestrictedIExcluded FROM APPROVED SOURCE CI 4. Food and Water from Approved Source 5. 5. 7. PROTECTION FROM CONTAMINATION 8. 9. 10. Proper Adequate Handwashing 12. Prevention of Contamination from Hands I313. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or Color Additives 15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Reporting of Diseases by Food Employee and PIC E116. Cooking Temperatures El 17. Cooling D19. Hot and Cold Holding 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP ReceivinglCondition TagisecordsIAccuracy of Ingredient Statements Reheating Conformance with Approved ProcedurestHACCP Plans Food Contact Surfaces Cleaning and Sanitizing CONSUMER ADVISORY El 11' Hygienic Practices 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000!Federa Food Code. This report. when signed below 23. 24. 25. 26. 27. 28. 29. 30. Management and Personnel Food and Food Protection Equipment and Utensils Water, Plumbing and Waste Physical Facility Poisonous or Toxic Materials Special Requirements (590009) Other by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations Cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: InspecturhsSignature: riff-L.- (A, 4:1 I?m" [OI/?en Kt OWL {73x Siulmture: Page?of;I?ngcs I FORM A SULKIN Iirlt'tuluz' brint: 6:26ij Violations Related to Foodbome illness interventions and Risk Factors (Red items 1-22) FOOD PROTECTION MANAGEMENT Assigment of Responsibility" 590.0038) Demonstration of Knowledge' 2-1011 1 Person in charge - duties EMPLOYEE HEALTH Responsibility of the person in charge to require reporting by food employees and applicants"'r Responsibility Of A Food Emplyee 0r An Applicant To Report To The Person In Charge?r Reporting by Person in Charge* Exclusions and Restrictions" Removal of Exclusions and Restrictions FOOD FROM APPROVED SOURCE I4 Foodend Water From Regulated Sources Compliance with Food Law" 3-201 . 12 Food in a Hermetically Sealed Container" 3-201.1 3 Fluid Milk and Milk Products* 3-202. 13 Shell Eggs" 3-202. 14 Eggs and Milk Products. Pasteurized* 3-202. 16 Ice Made From Potable Drinking Water" 5-101.11 Drinkingjfater from an Approved System? Bottled Drinking Water" 590.com? Water Meets Standards in 310 CMR 22.o* Shell?sh and ?sh from an Approved Source 3-20] .14 Fish and Recreationally Caught Molluscan Shell?sh? 3-201 . 15 Molluscan Shell?sh from NSSP Listed Sources* Game and Wild MushroomsApproved by RegulatoryAutlrortty 3-202. 18 Shellstock Identi?cation Present? Wild Mushrooms* 3-201.l7 Game Animals* ls 3-202.II PHFs Received at Proper Temperatures? 3-202 . 5 Package Integrity? 3-101.1 1 Food Safe and Unadulterated* 6 Tagsi?ocords: Shellstock 3-202.18 Shellstock Identi?cation* 3-203. 12 Shellstock Identi?cation Maintained? Tagslliecords: Fish Products 3402.11 Parasite Destruction* 3-402. 12 Records, Creation and Retention? 590.0040) Labeling of Ingredients' Conformance with Approved Procedures JHACCP Plans . 3-502.1 1 Specialized Processing Methods" 3-502. 12 Reduced oxygen packaging, criteria? 8-103.12 Conformance with Approved Procedures* Denotes critical item In the Federal 1999 Food Code or 105 590.000. PROTECTION FROM CONTAMINATION Cross-contamination Raw Animal Foods Separated from Cooked and RTE Foods? Contamination from Raw ingredients Raw Animal Foods Separated from Each Other* Contamination from the Environment 3-302.l Food Protection?r 3-302.15 Washing Fruits and Vegetables" 3-304.1 1 Food Contact with Equipment and Utensiis* Contamination from the Consumer 3-30.5. 14mm) Returned Food and Reservice of Food" Disposition ofAdulterated or Contaminated Food 3-701.ll Discarding or Reconditioning Unsafe Food? Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures" 4601.114 Chemical Sanitization - temp, pH, concentration and hardness* Equipment Food Contact Surfaces and Utensils Clean* 4-602. 1 1 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils" 4-7021 1 4-703. 1 1 Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment* Methods of Sanitization - Hot Water and Chemical* 2-301.11 Proper. Adequate Handwashing Clean Condition - Hands and Arms" 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* [11 Good Hygienic Practices I12 2-401.ll 2401.12 Eating, Drinking Using Tobacco" Discharges from the Eyes, Nose and Mouth? 3-301.12 Preventing Contamination When Tasting" Prevention of Contamination from Hands [13 Preventing Contamination from Employees* Handwash Facilities Conveniently Located andAccessible 5-203.11 5-204.11 Numbers and Capacities* Location and Placement* 5-205.11 Accessibility, Operation and Maintainance 6-301.11 Supplied with Soap and Hand Drying Devices Handwashing Cleanser, Availability 6301.12 Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN OF: CITY OF 7} Lin/wad Establishment Name: faxing/0L Date: page: Item Code Critical Item No. Reference Red Item PLEASE PRINT CLEARLY Date Verified (1th (#394; inci- 7? 38? 77 ??er5 Ottab?t-i S?x?v {mi 3 it. {3.17th . If.) ?If Mr'nfx?nr?m?ta MAIlie ?itting-C?) pofm?i? .3144. _Discussion With Person in Charge: Corrective Action Required: No Yes El Voluntary Compliance Re-inspeclion Scheduled Cl Embargo CI Voluntary Disposal Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other: Form 734 A.M Sulkin (30.. Boston. MA 3-501 . PHFs Received jit?Temperatures Violations Related to Foodbomo Illness Interventions and Risk According to Law Cooled to Factors (Red items 1-22) (Cont) Within 4 Hours. 3-501.15 Cooling Methods PROTECTION FROM EHEMICALS Food or Color Additives l9 PHF Hot and Cold Holding Cold PHFS Maintained at or below I I . 3 202.12 Addltives 590.0040?) 410/450 3-501 Hot Pl-[Fs Maintained at or above . . . . . 7-101.? [dent in infonnatlon 0n inai coring?: 3501-1600 Roasts Held at or above 7-1 02.11 Common Name - Working Containers' i 20 Time 39 a Public Health Control 7-2021 1 Restriction Freseitce and Use- 59030400 Variance Requirement 7402.12 Conditions of Use" 7-20111 Toxic Containers Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.l Sanitizers, Criteria - Chemicals" 7.204.12 Chemicals for Washing Produce, Criteria? - 11 34501-1100 I?m-packaged Juices and 7-20404 Drying Agents, CriterE? Beverages With Wammg?abels' 7.205.11 Incide'ntnl Food Contact, Lubricants" 34?" .1 1(3) Use of Pasteunzed 3335* '7-206.ll Restricted USO Pesticides, Criteria" 3-8015] 10)) Raw or Animal 811d 7-206.12 Rodent Bait Stations" 3m? semd' . 7-206.l3 Tracking Powders, Pest Control and Unopened Food Package Not lie-served. Monitoring? CONSUMER ADVISORY 22 51-603.] 1 Consumer Adviso Posted for Consum tion of Ei'l' RAT NTROLS ry 16 EMPE Pi?opEr cgoklng Temperatures for Animal Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.1 Eggs- 15501": 15 Sec. Pathogens! M'm' Eggs. Immediate Service 1450F155cct 3-302-13 Pasteurized Eggs Substitute for Raw Shell Eggs" 3401.11 A 2 Comminuted Fish, Meats Game (- Animals 155?], ,5 sec. . SPECIAL REQUIREMENTS pol-k and 3?,me 13W 121 min. Violations of Section in catering mobile food, temporary and 3-401Eat'tes? Injected Meats sec reSIdentlal kitchen operations should be 3401.1 Poultly, Wild Game, Stuffed PHFs, debited under the aPPrOPriate sections Stuf?ng Containing Fish, Meat, above If related to foodbome I Poultry or 11310934650}: 15 see 0 interventions and risk factors. Other 3.401, 1 Intact Beef Steaks 590.009 violations relating to good retail practices should be debited under #29 3401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave All Other PHFs 1 5 see. It WOLA RELATED TO GOOD RETAIL PRACTTCES 17 Reheatlng tor I-lot (:Ifl?e it?? 23-39 i . h. hd I 3.4011] A . i. rmca an v10 attons3403 Pan '65 15 2 d' foodbarne interventions and risk factors listed above. can be . (B) Microwave- '65 mute tan mg found in the following sections of the Food Code and 105 CMR Tim" 590.000. 3-4011 Commercially Processed RTE Food - item 3-401] Remaining Unsliced Portions of Beef 24. Food and Food Roasts' - 4 .005 is Proper Cooling of PHFs 26- Water. and 6 007 3-501-140?) Cooling Cooked PHFs from to . . Within 2 Hours and From Tm": 7 to Within 4 Hours. 30, Other Cooling Made From Ambient Temperature Ingredients to Within 4 Hours? Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 590.000 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Federal Furnace Elementary In: I 10:41: I 7_3.19 Focdbornv mm: 55' risk factors are Important practices or procedures Address: 350 Federal Furnace Rd Inspection by: Marcia Lee Identified as the most prevalent contributing factors of foodborne Phone: 503.33 0.4350 Signature: illness and/or injury. Public health interventions are control measures Last Insp. Date: unknown Received by: used to pretrent such foodborne illness andicr Injury. Furnace of Inspection: Routine Signature: Types oi Inspection: Routine. rte-Inspection. HACCP, Pre?Operation, Type ct Establishment: 5: best food service Email: Suspect Illness. Complaint. or Other ticemefPem-ii't Number. not present Business Email. To replace corrupt d13ita file SOURCE OF FOOD Point IN OUT NIO NIA COS ITE Code Approved source for food. water.and ice; received at proper temperatures, wholesome. 1 nonadulterated. in good condition. records available ?3?201.11. ?3?202 11. ?3?202 15 3 590 DUSIAI 2 items mum be properly dine marking A disposition: date prepared. date Item. date 2 . . Iii-awed. amnion ?a ?3_5m 18_ $5601 17 2 2 590 007 Mid?" preparatlon dates and expiration dates for foods not day of reciept ITEM F000 PROTECTION Point:- IN out Nip NIA cos ITE Code 3 Potentially hazardous food meets temperature requtrements dunng storage. preparation. 3 3 cooking. cooling. reheating, holding, display. service. and transportation ?3?401 .11. 590 003 4 Ada-quarto lac-Mes In Mamba-n ormucl Illerrmmetm Prev-doc 1 4 590 004 3? 0v er.- calibrated stern thermometer for food :ir-itni-Jdtd-i-t Thermometers are present. conspicuously placed. accurate. calibrated. present 1 5 590 003 5 Potentially hazardous food properly thawed 2 5 3' Proper disposition of returned. previously served. reconditioned. and unsafe food ?3-306 14 2 7 590 003 3 Foe-d protects-cl during etc-rage. preparation. display. games .5 transportation Food 3 containers stored floor Washing fruits and vegetables ?3-302 11. ?3-304 11. 304.15IAI. 3 590 003 9 No bare hand contact with ready?to-eat foods. proper utensils used. or approved alternate 9 rndhod properly bllowed ?3-301 ?301 11(D)(1H2)Good hygienic practices. proper handwashing and glove changing observed ?2-301 11. ?2?301 12, ?2-301 14 3 at 590 003(0] In use Food dispensing utensil?u pic p-dily stored 1 10 590 003 Point: IN ITE Code COMMENTS Management awareness; Proper use of reporting. proper restriction exclusion for 11 reportable diseases ?2?201 11. ?2-201 12, ?2?201 13 No discharge from eyes. nose. or 590 002 mouth observed. 52401.12 3 it Proper eating. tasting. drinking Smoking restricted 590 002 UTEHSILS: INSTALLATION Points OUT MM (:05 ITE Cede Food-contact surfaces designed. constructed. maintained. Installed. located 2 14 590 007 Nonfood-oontact surfaces designed. constructed. maintained. installed. located 1 15 590 on? Dishwashing facilities approved design. adequately constructed. maintained. installed. 15 located 2 530 004 Proper chemical test Kits, measuring devices [or ph. thermal strips. and logs are present 17 590 004 Temperature and csi na nes are accurate 4?501 113 1 it Provide log sheet Tablewares and Equipment is pro-?ushed. scraped. and soaked prior to cleaning 13 1 590 004 Wash and rinse water is clean, and at proper temperature 2 it 19 590 005 Sanitizaticn rinse (hot water - chemical) Proper sanitizaticn of bod contact surfaces through temperature. chemical concentration. exposure time for equipment and utensils 501 590 004 3 20 - PROTECTION FROM CONTAIINATION Points IN OUT NIO COS ITE Code COMMENTS Wiping cloths properly stored clean and dry or in a sanitizing solution 21 590.003 2 590.004 Food-contact surfaces of utensils equipment clean ?4u-602 11 2 22 590 004 Nonfood-contact surfaces of utensils 5 equipment clean 1 23 530 004 Proper equtpmentlutensils storage. handling. to prevent contamination 24 590 004 26 Court St. Plymouth, MA 02360 Tel: 508-747-1520. Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM PROTECTION FROM CONTAMNATION Points IN OUT NIA COS ITE Code COMMENTS 25 p?pf'c Single service articles are from an approved source. are stored, handled, dispensed, used manner that prevents contamination 1 25 pf. No Ire-use of single semen containers for Food or chomcsl storage 1 26 590 004 ITEM thapl? WATER SUPPLY a. DISPOSAL Point: IN OUT NIO NIA COS ITE Code COMMENTS 27 Water supply is from an approved source and water supply is sut?cient for the operations in! 3 27 530 005 23 Sewage disposal approved Proper disposal of waste water in approved disposalfacilities (ie 23 590 005 slo sinks) 3 "maple IPLUIBING WT IN OUT HID NIH. ITEM Code Location. installation. maintenance lie dripping faucets. leaking pipes. improperly wasting pa; 1 29 590 005 COMM ENTE 30 p. pf Plumbing installed preventing cross connection, back siphonage. back?Adequate handwaehing facilities. easily accessible. designed. installed ?5~202 12 31 590 one 3 3 G'Tlv "lord 32 pf'c Toast localities proww sotlclosrrig doors. fissures in goal: rue-arr supplied 32 with soap and towels in dispensersll hand-drying devices. cleaned. covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do 590 006 not open into areas where food is exposed to airborne contamination and are adequately 590 005 separated from food processing and storage areas 2 n; Hemp-pin FACILITY AND GROUNDS Points IN OUT Nr'o m?A cos ITEM Code Sui?cernt covered trash recepticles present In adequate number, leak proof, insectlrodent 33 590 005 roof. ern tied with ads uate fre Llenc clean 2 34 pm: Outside premises are free from trash. etc . free of harborages. breeding places for rodents. 34 insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate 590 005 drainage and do not constitute a source of contamination Controlled incineration 2 It 35 Doors, windows. and other openings are protected to eliminate entry by insects, 35 590 006 mgmu 5_ No ondencc pf prosonl 3 3 Evidence of mice in the office :ropn rial. noted. ITEM FLOORS. WALLS 8- CEILINGS Points IN OUT NIO NIA COS ITEM Code COMMENTS 35 Proper floor construction, proper ?oor covering installed, floors graded With drained as 36 required, ?oor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 006 methods used as needed 1 It Walls, ceilings, attached equipment, properly constructed. good repair, clean Well a 37 9 surfaces as required Dustless cleaning methods used as needed 1 37 590 006 Seal holes in ceiling around pipes that may provide access to mice. 33 Adequate lighting provided for suf?cient candle light Fixtures property shielded or use of 3a 590 out; shatter proocl bulbs 1 39 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms 39 590 one and prevent contamination bv dust, andlor other airbome substances 1 1 Hood not tagged with date of cleaning 40 40 Locker rooms, employee changing areas, provided. located to prevent contamination of production areas, and used for storage of employee personal items properly equipped and 590 004 properly ventilated Dressing rooms are maintained in good physical repair. 1 41 41 Insecticides and rodenticides are used and stored so as to prevent contamination of food items Detergents. sanitizers and other cleaning supplies are used in a safe. elfective 590 007 mariner. Hazardous materials are kept in their original containers and stored separate from raw materials ?7-202.12, ?7~203.11, 57-101 11, ?7-201.11 3 42 Premises maintained li?ee oflitter, unnecesary items and articles. cleaning maintenance 42 590 006 odurprnonl nmoo?v slum-d 1 Separation of maintenance rooms and equipment, facilities by partition 1 I 43 599mg 44 soiled linens property stored 1 44 590 004 ITEM PERSON IN CHARGE Points- IN OUT NIO ICOS ITE Code COMMENTS 45 Certi?ed Food Protection Manager ?2?102 present, knowledgeable, understands sanitary controls, demonstrates 45 59mm knowledge, performs duties. ?2-103.11 3 59mm A 26 Court St. Plymouth. MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM HIGHLY POPULATIONS Poinu Code Pestuerized foods used: prohibited 1bods not offered. 53?801 11 47 590 003 3 n: Phat-mph: ADDITIVES Points In our taro MIA cos ITE Code 43 Food and properly used. 53-202 12 2 48 590 003 EQUIPIENT AND UTENSILS Point IN OUT HID MIA {:05 ITE Code COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough 49 550 can to avoid contamination of food products. 2 50 pf Instruments and controls used for measuring, regulating. or recording temperature pH, acidity. water 50 activity. or other conditions are accurate and adequately maintained and calibrated 590 004 1 It 51 Molluskan Shellfish Tanks maintained. tested. and logs kept 1 51 590 no: may: menu-anus HEALTH PROCEDURES PointCode comments 52 Pf Procedures for responding to vomiting diarrhea] events. ?2-501.11 1 52 590 002 CONSUMER ADVISORY POSTED Points OUT [205' ITEM Code COMMENTS Consumer Advisory Posted ?3?603.1l 1 I 53 590 003 Phebe-ash: SPECIAL PROCESSES Poin?B IN OUT HID Nf? COS ITEM Code 54 Reqmred records available; shellstock tags, parasIte destructIonJIme As a mom: Health 54 590 on! Control re uired lo . 53?20112. 93402 11. ?_3?402 12, 3 3: Co with 83403 l2. 2 a 55 550 warn CONFORMANCE WITH APPROVED PROCEDURES Point IN OUT NIO NIA COS ITEM Code COMMENTS Allergen Certificate I 590 0111A) AnII-CI?I-ultln ?4 590 011 [Al Local BDH Regulation . local Firm is currently licensed by the regulatory authority having jurisdiction it local WIN RECORD CHECKLIST ITEM Code COMMENTS Water quallty and supply records. grease trap cleanIng record, ansul system cleanlng records and taas current, Fire extinouisher ta 3 current Employee training records it Temperature control records It Equipment monitoring and maintenance records Calibration records It Sanitation records it Required Logs; Time as a Public Health Control, Receiving Temperature. parasite destruction 1 590 DOB Pest control records Variance request and approval. Time as a Public Health Contml Procedure I: 590 003ml Inspection records {a . incoming product. lacilily. production area) it ITEMS OBSERVED IN: In Compliance In Red Risk Factors Observed [Priority] DIS. Deducted 3 OUT: Out of Compliance In Blue Good Retail Practices Observed {Priorlly Foundation. Core] pts. Deductsd 3 Not Observed Total Non-Corn pliant Observations total points deducted 11 MIA: Not Applicable SCDR E: 89 C05: Corrected on Sight ?Violatlons cited must be corrected within the time frames in section 8435.11 or in dates otherwise written In the report. It: Repeat Violation 26 Court St Plymouth. MA 02360 Tel: 508?747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation] 2013 Federal Food and Drug Administration Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation offood establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Temperatures Taken: ADDITIONAL NOTES: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Nettles Elemen'tiry' In: I 1:30 lone] 15.1120 Foodbc-mi: illness risk tactic rs are Important practices or procedures Address: 253 Standish Ave inspection by: Marcia lEe Identified as the most prevalent contributing factors of foodborne Phone: 50333043100 Slgnature: illness and/or injury. Public health interventions are control measures Last Insp. Date: unknown Received by: used to prevent such foodborne illness andr?ar inrury. Purpose of Inspection: routine Signature: Types of inspection: Routine, Re-Inspection, HACCP. Pre-Operation, Type School Email: Suspect Illness. Complaint. or Other Number: Business Email: SOURCE OF FOOD Points IN OUT NIO NIA COS ITE Code COMMENTS Poms-mud source For bod. ?Marlena Ice: repulsed at proper temperatures. ??atworm. 1 nonadul?terated, in good condition. records available. 53-201 11. ?3?202 11. ?3?202 15 3 5-90 DUZIAI Items mind be properly dun marks-lg a disposition dale prepared dale homo. date 1 1 mm. mm?IIJt'l dais ?3501.18_ ?3-501.17 2 590 00; FOOD Point; IN OUT NIO NIA COS- ITE Code COMMENTS Potentrally hazardous ibori meets temperature requrrements during storage. preparation. 3 3 cooking. cooling, reheating, holding. display. service, and transportation ?3?401 11. 590 003 501,14_ 11. 53-501 16, 634501.19 Adequate facilities to maintain product temperature. thermometers provided hammp maroon-elm are pracam. conspicuously placed. accurate. calibrated. present at 5 550 003 Potentially hazardous food pmperly thawed 2 6 Proper disposition of returned, previoust served. reconditioned. and unsafe food ?3?306.14 7 590 003 3 p,pf'c Food protected dunng storage, preparation. display, servroe 8 transportation Food 3 containers stored olf floor Washing fruits and vegetawa ?3-302 11. ?3-304.11. 3 590 003 9 p,pf,c No bare hand contact with ready-to?eat foods, proper utensils used, or approved alternate 9 method properly bllowed ?301 hygienic practices, proper handwashing and glove changing observed 52-30111. ?2-301.12. ?2-301 14 3 590 003(0) In use food dispensing utensils properly stored 1 10 590 [m3 EWLOYEE HEALTH Points IN OUT NIO NIA COS ITE Code COMMENTS Management awareness; Proper use of reporting. proper restriction exclusion for 11 reportable diseases. ?2?201 11. ?2?201 12. ?2?201 13 No discharge from eyes. nose. or 590 002 mouth observed. ?2~401 12 3 Proper eating, testing. drinking Smoking restricted ?2?401 11, ?3?301 590 002 EQUIPMENT 8. UTENSILS: a INSTALLATION Points In our mm m5 Code mMME?'fs Food-contact surfaces designed. constructed. maintained. installed. located 2 14 590 on? Nonfoocl?contact surfaces designed. constructed, maintained. installed, located 1 15 590.007 Dishwashing facilities approved design. adequately constructed, maintained. installed, 15 located 2 590 004 17 Proper cnemIcaI test Kits. measuring devices tor ph, thermal strips. and logs are present 17 590 004 Temperature and psi causes are accurate 4-501 113 1 keep log. sheet for dishwasher and chemical sanitizer 13 Tablewares and Equipment is pro-?ushed. scraped, and soaked prior to cleaning 13 1 1 590 004 13 Wash and rinse water is clean. and at proper temperature 2 19 590 005 Sanitizatlon rinse (hot water - chemical) Proper eanitization ofiood contact surfaces through temperature, chemical concentration. exposure time ior equipment and utensils 501 111-115. ?4-703 590 004 20 3 20 PROTECTION FROM CONTAMNATION Points IN OUT NED tTElldEode COMMENTS Wiping cloths properly stored clean and dry or in a sanitizing solution 21 590.003 2 590 004 Food-contact surfaces of utensils 8. equipment cison 9-602 11 2 22 590 004 Maniacs-contact surfaces dfulorrsits clean 1 13 Proper storage. handling. to prevent contamination 1 34 550.013.: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Phat-valiant? PROTECTION FROM CONTAMNATION Point. IN OUT COS ITE Code ENTS Single service articles are from an approved source. are stored, handled, dispensed. used 25 590 004 and disposed ofin a manner that prevents contamination 1 No re-use of single service containers for food or chemical storage 1 3 25 590 004 manta WATER SUPPLY DISPOSAL Points IN OUT Code COMMENTS Water supply is from an approved source and water supply is su?icient forthe operations int 3 21 590 DDS Swans dllm?i appmvod Pippin disposal or waste water in approved disposalfacilities he 28 530 005 step 5min 3 ITE mam IPLUNBING WT IN OUT MID was cast Tr Code Location. installation. maintenance (ie dripping faucets. leaking pipes, improperly wasting pii 1 1 29 590 005 needs grease trap propezty Installed. Plumbing installed .. a cross back .7 back?ow. 2 30 590 005 Adequate handwashing facilities, easily accessible. designed, installed ?5-202 12 31 590 005 3 Toilet facilities: properly constnicted. self closing doors. ?xtures in good repair. supplied 32 with soap and towels in dispensers! hand-drying devices. cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have doors and doors do 590 DDS not open into areas where food is exposed to airborne contamination and are adequately 550 DDS separated ti'om food processing and storage areas 2 Pains IN OUT Nit} ITE Code 33 Su?iceint covered trash recepticles present in adequate number. leak proof. insect/rodent 33 590 005 uatu iruquuncy. clean 2 34 Outside premises are free from trash. etc . free of harborages. breeding places for rodents. 34 insects. and other pests Outside areas (roads. yards. disposal systems) provide adequate 590 006 drainage and do not constitute a source ofoontamination Controlled incineration 2 35 Doors, windows. and other openings are protected to eliminate entry by Insects. 35 590 006 rodents! eats No evidence of ests resent 3 HEM Photompns FLOORS, WALLS 8: CEILINGS Point: IN OUT HID N?i COSI ITE Code 35 .3 Proper ?oor construction. proper ?oor covering installed. ?oors graded with drained as 35 required. ?oor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 one methods used as needed. 1 Walls. ceilings. attached equipment. property constructed. good repair. clean Wall 8. 37 ceiling surfaces as required Dustless cleaning methods used as needed 1 37 590 006 3B Adequate lighting provided for sufficient candle light Fixtures properly shielded or use of 33 590 ODE shatter mod bulbs 1 39 Air quality and ventilation are adequate to remove excesswe heat for equipment and rooms 39 590 004 and revent contamination dust andi?or other airborne substances. 1 40 40 Locker rooms, employee changing areas. provided. located to prevent contamination of production areas. and used for storage of employee personal items properly equipped and 590,004 properly ventilated Dressing rooms are maintained in good physical repair. 1 41 41 Insecticides and rodenticides are used and stored so as to prevent contamination of iced items. Detergents. sanitizers and other cleaning supplies are used in a safe. effective 590 no? mariner. Hazardous materials are kept in their original containers and stored separate from raw materials 12. 57-203 11. 57-101 11. ?7?201.11 3 )t 42 Premises maintained free of litter. unnecesary items and articles. cleaning maintenance 42 590 DOS ui mere properly dioreii 1 Separation of maintenance rooms and equipment. laundry facilities by partition 1 43 590 004 Soda-d futon: property storm. 1 44 590 004 PERSON IN CHARGE Points IN OUT NIA IT .Code COMMENTS Candied Food Protection Manager 3 45 590 002 PIC is present. knowledgeable, understands sanitary controls. demonstrates 45 590.002 knowledge. performs duties. ?2?103.11 3 590.00; A 25 Court St. Plymouth. MA 02360 Tel: 508-747-1520, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM WW5 HIGHLY SUSCEPTABLE POPULATIONS Poin? IN OUT HID NIA COS ITE Code Paetuerized foods used: prohibited foods not o?ered. ?3?801 11 47 $90 003 3 Photon-am FOODICOLOR Polnti IN OUT Nfo NIA cos I Code 45 Food edditimapprovea and property used ?3?202.12 2 48 590 on; Photos-aim EQUIPMENT AND UTENSILS Points IN OUT NIO NIA COS Code COMMENTS 49 All made one equipment an: alumni encl some at Marvel: that are Frequent mush 49 $90 004 to avoid contamination of food ucts. $4402.11 2 50 Innimmis Irina. communism Ior mrm, regule-g, or {downturn pH_ peed-L wafer 50 array cor-name ore ?eet-rpm and admu?eir mentored and Cinnamon 590 004 1 51 Motluiiun Wll?oh Tam mamienno Ida-too and lag: trip: 1 51 530 004 mm mum H-EALTH pnocepuTaEs PointCode COMMENTS 52 Pf Procedures for responding to vomiting 8.: diarrhea] events. ?2-501.Il 1 1 52 590 002 1TEM CONSUMER ADVISORY POSTED Point: IN OUT NIO NIA cos ITEM Code COMMENTS 53 Consumer Advisory Posted ?3-603. II 1 I 53 590 no: SPECIAL PROCESSES Points IN OUT NH) NIA C05 ITEM Code Iteqmred records available; shellstock tags, parasrte destruction,lime As a Public Health 54 590 on: Control re uired IO 5. ?3-203.12, $402.12. 53?20118 3 I: Co liapoe 'th ACCP [?t?10312 2 I 55 malts CONFORMANCE WITH APPROVED PROCEDURES Poln? IN OUT MIA COS ITEM Code COMMENTS I 550 Anti?Choking - 590 011 (Al G. Local BOH Regulation .4. local Firm is cu rren'tlv licensed by the regulatory authority having jurisdiction at local RECORD CHECKLIST ITEM Code COMMENTS Water quality and supply records. grease trap cleaning record, ansul system cleaning records and tags current Fire extinguisher lags current Employee training records it Temperature control records it Equ-prI-Ieni n-Icrutonng and mnmimnncu records it Calibration records I. Sanitation records 1 Required Logs; Time as a Public Health Control, Receiving Temperature, parasite . 590 one destruction Pest control records Variance request and approval, Time as a Public Health Control Procedure 530 Build) Inspection records (e . incoming product. facility. production area) ITEMS OBSERVED iN= In Compliance Risk Factors Observed {Priority} pic. Deducted OUT: Out of Compliance Good Retail Practices Observed {Priority Foundation. Core} ple. Deducted 6 MO: Not Observed Total Non-Compliant Observations total ppinrs deducted 6 Not Applicable SCORE: 94 C05: Corrected on Sight ?Violations cited must be corrected within the time frame: In section $185.11 or in dates otherwise written in the report. R: Repeat Violation 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION VFORM w? ADD. LGNAL NOTES: Temperatures Taken: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs Mobile Date: Owner SQ Q) HACCP YIN Bed Breakfast El General Complaint Inspector ZLI/rte Out' Permit No. Other Violations Related to Foodborne Illness Interventions and Riel: Factors; (Red Items) Antl-Choklng 590.009 (E) FOOD ESTABLISHMENT INSPECTION REPORT Name - Operation(s( Type'?f Inspection I (Lot (SOIL LI fiji cod Service gRoutine Address Risk DRetail Re-inspection STU t1 Level Residential Kitchen Previous Inspection ep one .. It 3? LL23 Temporary Pro-operation Caterer EISuspect Illness Person In Charge (PIC 6g Time (Lift/If?. 2031? On In. HACCP Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non- -compliance with: Violations marked may pose an imminent health hazard and require immediate corrective TODBOGO 590-009IF) action as determined by the Board of Health. Allergen Awareness 590.009 (G) Elmo PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands 1. PIC Assi ned I Knowled eable I Duties .. . 9 I313. Handwash EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 14. Approved Food or ColorAdditives 15. Toxic Chemicals RE CONTROLS (Potentially Hazardous Foods) El 2. Reporting of Diseases by Food Employee and PIC 3. Personnel Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source CI 5. ReceivingICondition [115- Cooking Temperatures 6. TagsIRecordsiAccuracy Reheating El 7. Conformance with Approved Procedures/HACCP Plans 18? Cooling PROTECTION FROM CONTAMINATION 19- Hot and COM ?Olding 8. 20- Time As a Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 9. Food Contact Surfaces Cleaning and Sanitizing 21 Food and Food Preparation for HSP 10. ProperAdequate Handwashing 11. Good Hygienic Practices CONSUMER 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected TO Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22); - of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an . order of the Board of Health. Failure to correct violations 24' Food and Protection cited in this report may result in suspension or revocation of 25' EqUIpment and UtenSIls the food establishment permit and cessation of food 26- Water, Plumbing and Waste establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be in writing 23- POISODOUS or TOXIC Materials and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 23. Management and Personnel Inspector?s Signature: ?#1;er .. It? .?v?xk l?rint: It". IJICI. Signature: /ijf 'lLt' e'jl?T' Print: [[11 /::r/7jj/7 I FORM 734A AM SULKIN CO i I i j} Violations Related to Foodborne Illness interventions and Risk Factors (Red items 1-22) FOOD PROTECTION MANAGEMENT Assignment of Responsibility? 590.0038) Demonstration of Knowledge? 2-103.ll Penen in charge - duties EMPLOYEE HEALTH 2 Responsibility of the person in charge to require reporting by food employees and applicants? 590.0039") Responsibility Of A Food Emplyee Or An Applicant To Report To The Person In Charge" Reporting by Person in Charge" 590.003fD} Exclusions and Restrictions* 59000305) Removal of Exclusions and Restrictions FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sources Compliance with Food Law* 3201.12 Food in a Hermetically Sealed Container? 3-201.l3 Fluid Milk and Milk Products" 3-202.13 Shell Eggs? 3-202. 14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water* 5-101.ll Drinking Water from an Approved System* Bottled Drinking Water* Water Meets Standards in 310 CNIR 22.0* Sirei?'ielr and ?sh item anAppmved Source 3-201.14 Fish and Recreationally Caught Molluscan Shell?sh" 3201.15 Molluscan Shell?sh from NSSP Listed Sources* Game and Wild Mushrooms Approved by RegulatoryAutllorlty 3-202.18 Shellstock Identi?cation Present"r Wild Mushrooms* 3-201.17 Game Animals* ReceivingiCondition 3-202.? PI-IFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated* r5 Tagsl?ecords: Shellstock 3-202. 18 Shellstock Identi?cation* 3-203.12 Shellstock Identi?cation Maintained? Tagol?ecords: Fish Products 3402.11 Parasite Destruction* 3402.12 Records, Creation and Retention" Labeling of Ingredients' Conformance with Approved Procedures Plans 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging, criteria? 8403.12 Conformance with Approved Procedures* Denotes critical item in the Federal 1999 Food Code or 105 590.000. PROTECTION FROM CONTAMINATION Cross-contamination Raw Animal Foods Separated from Cooked and RTE Foods" Contamination from Raw ingredients 3-302. 1 Raw Animal Foods Separated from Each Other" r Contamination from the Environment 3-3011 3-302.15 Food Protection* Washing Fruits and Vegetables* 3-304. 11 Food Contact with Equipment and Utensils? Contamination from the Consumer Returned Food and Reservice of Food" Disposition or Contaminated Food 3-701.Il Discarding or Reconditioning Unsafe Food* I 9 Food Contact Surfaces 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures? 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures? 4501.114 Chemical Sanitization - temp, pH, concentration and hardness* Equipment Food Contact Surfaces and Utensils Clean?lr 4-602. 1 1 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* 4-702.? Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment* 4-703.l 1 Methods of Sanitization - Hot Water and Chemical? Proper, Adequate 2-301.11 Clean Condition - Hands and Arms* 2-301.12 2-301.14 Cleaning Procedure* When to Wash" [11 Good Hygienic Practices 24101.11 24101.12 Eating. Drinking or Using Tobacco* Discharges from the Eyes, Nose and Mouth" 3-301.12 Preventing Contamination When Tasting"r [12 Prevention of Contamination from Hands 13 Preventing Contamination from Employees" Handwash Facliltios Conveniently Located and Accessible 5-203.1 1 Numbers and Capacities" 5-204.11 Location and Placement" 5-205.? Accessibility. Operation and Maintainance 6-301.? Supplied with Soap and Hand Drying Devices Handwashing Cleanser, Availability 6-301.12 Hand Drying? Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN on CITY OF 6?me Establishment Name: till! QLA. 1&me Mfg; Date: page: .. .. Item Code c-Gr'umlnam .. - -. Date No. Reference R?Retl Item PLEASE PRINT Verl?ed Ni)? 1 ?53, a ?My 9- WM 534295 a 0M Egg, t/ NM ur3271)" WM W0 01-3th Discussion With Person in Charge: Corrective Required: '3 N0 El Yes Voluntary Compliance El Employee Restrictionl Exclusion El Re-inspection Scheduled 0 Emergency Suspension El Embargo El Emergency Closure 0 Voluntary Disposal CI Other: Form 734 AM. Sulkln 00.. Boston. MA Violations Related to Foodbomo illness interventions and Risk Factors (Rod [talus 1-22} (Cont) PROTECTION FROM CHEMICALS 114 Food or Color Additives 3-202. 12 Additives? 3-302.l4 15 Protection from Unapproved Additives? Poisonous or Toxic Substances 7-101.? 7-102.? Identifying information Original Containers? Common Name - Workingpontainers? 7-201.? Separation Storage'l' 7-2021 1 7-202. 12 Restriction -- Presence and Use' Conditions of Use? 7-2011 1 Toxic Containers Prohibitions" 7-204.l Sanitizers, Criteria Chemicals" 7-204.12 Chemicals for Washing produce, Criteria" 7-204. 14 Drying Agents, Criteria" 3-501.15 rears Received al'fempemtum According to Law Cooled to Within 4 Hours. Cooling Methods for PHFs l9 PHF Hot and Cold Holding 590.0040) Cold PHFs Maintained at or below 41?l45? F'l' Hot PHFs Maintained at or above Roasts Held at or above 120 Time as a Public Health Control 3-501.l9 Time as a Public Health Control? Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS 2] Unpasteurizcd Pro-packaged Juices and Beverages with Wanting Labels? 7-2011 1 Incidental Food Contact, Lubricants" 7-206. 1 1 Restricted Use Pesticides, Criteria" 7406.12 Rodent Bait Stations? 7-206.? Tracking Powders, Pest Control and Monitoring' CONTROLS 3-80i.i 103) Use of Pasteurized Eggs" 3-801.1 Raw or Partially Cooi?d Animal Food and Raw Seed Sprouts Not Served. Unopened Food Package Not lie-served. CONSUMER ADVISORY 16 Proper Cooking Temperatures for PHFs Eggs- 15 Sec. Eggs- immediate Service i45?FiSsec* 22 3-601] i Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or Not Othenlvise Processed to Eliminate Pathogens.? M'm? 3-302. 13 Pasteurized Eggs Substitute for Raw Shell Eggs? Comminuted Fish, Meats Game Animals - 15 sec. SPECIAL REQUIREMENTS 3-401-1 Pork and BeefRoast - 121 min? 3-401 .1 Ratites, Injected Meats 15 sec. 3401.1 Poultry, Wild Game, Stuffed Pl-iFs, Stuf?ng Containing Fish, Meat, Poultry or Retires-165$ 15 sec. 3-401 .1 Whole-muscle, intact Beef Steaks i45?F 3401.12 Raw Animal Foods Cooked in a Microwave Violations of Section in catering, mobile food. temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 Special Requirements. All Other 15 see. 17 Reheating for Hot Holding PHFs 15 see. 3403.1 1(a) Microwave- 165? 2 Minute Standing Time? 3403.1 Commercially Processed RTE Food - 3-4011 Remaining Unsliced Portions of Beef Roasts? Proper Cooling of Cooling Cooked Pi-lFs from to Within 2 Hours and From to Within 4 Hours. Cooling Pl-iFs Made From Ambient Temperature ingredients to Within 4 Hours? Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. WOLA RELATED TO GOOD RETAIL PRACTICES (Blue items 23-30) Critical and non-critical violations. which do not relate to the foodborne illness interventions and risk jot-tors listed above. can be found in the following sections of the Food Code and MS CMR 590. 000. Good Retail Practices and Food Protection and Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Address: 1131 State Rd Phone: 508-830-4379 Last lnsp. Date: 12/19/17 Risk Category: High MAME: Indian drank Elementary Purpose of Inspection: Routine Type of Establishment: Food Establishment {Schooll license;r Permit Number:Faod Establishment 438 .Mllk 439 Time In: 12:15 Inspection by: Marcia Lee Signature: PIC Received by: Caryn Eaton Signature: Managers Email' Ceatcn@plymouth.k12.ma.us Pormit Holder: Plymouth School System Corporate Ema Time Out:2:30 Foudhornc illness risk [actors are important practices or procedures identi?ed as the most prevalent contributing factors of focdborne illness and/or injury. Public health interventions are control measures used to prevent such loodb-pme illness andfor injury. Types ol' Inspection. Routine, Re?Inspection, HACCP, Pre~0peration, Suspect Illness, Complaint. or Other Reinspection Date: 2/11/2019 ITEM Photomphs SOURCE OF FOOD Points IN OUT NIO NIA COS COMMENTS 1 Approved source for food, waler,and ice; wholesome, nonadulterated 3 1 All loods must be stored in airtight, covered, labeled recepticles designed for the Intended use Foods must be labeled to identity Jates are for expiration to ensure oldest product Is used first. Foods once prepared [00d bY 00mm? "ama- data 0f Pmduc?om data 0f freezing, thawing, preparation, and expiration. must have preparation date and expiration date labels for RTE foods lf frozen mark date frozen and date thawed in addition to preparation date with new expiration 1 date from thaw date of 7 days FOOD PROTECTION Points IN out are We cos COMMENTS Potentially hazardous food meets temperature requirements during storage, preparation, cocking, cooling, holding, display, sewice, and transportation Salad was tested at an internal temperature of 52 SF, there are no cold holding units the school The school uses reusable ice cube packs placed under a metal insert on the hot holding line to maintain cold temperature but it is not provide sufficient surface temperature to keep foods at required temperatures. Discussed plating 3 3 salad and holding in a cold reachin to maintain temperatures. Adequate facilities to maintain product temperature, thermometers PmVided No ice machine, no cold line holding unit, freezer was not maintaining food hard to 3 3 the touch Thermometers provided and accurate, propeny calibrated 1 Potentially hazardous food properly thawed 2 It Unwrapped or potentially nazardous food not reserved 2 Food protected during storage, preparation, display, service transportation Food mntainers stored ort floor Washing fruits and vegetables 2 some items are on shelves without a 6" clearance off the ground. Handling of l'o-oc and Ice minimum No can: hand concoct With ready-tonal foods. proper utensils used. or approved alternate method properly followed 3 In use food dispensing utensils properly stored 1 EMPLOYEE HEALTH Points IN OUT COS COMMENTS Management awareness; Proper use of reporting, proper restriction exclusion for reportable diseases No discharge from eyes, nose. or mouth observed 3 it Proper eating, tasting, drinking Good hygienic practices, proper handwashing and glove changing observed, smoking restricted 3 Proper hair and beard restraints are worn correctly, clean uniforms. kitchen whites. and aprons. thIr-Phs EQUIPMENT 5. UTENSILS: DESIGN.CONSTRUCTION 5. INSTALLATION Points IN OUT Milo NIA cos COMMENTS Food-contact surfaces designed, constructed, maintained, installed, located 2 Monica-comes: surlacoa designed. oorotructud. maintained. Faceted Provide storage units for the intended use 6" clearance off the floor and with 1 1 non?impervious, easily cleanable surfaces. Dishwasning faculties approved design, adequately constructed. maintained, installed, located 2 3: Proper chemical test kits, measuring devices for ph. then-rial strips, and logs are present Temperature and psi gauges are Need thermal strips. No thermal strips for verifying the hot water sanitization accurate 1 1 process. Tablewares and Equipment is pro-flushed, scraped, and soaked prior to cleaning 164 172 but tested at 160 at plate surface San ation rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature, chemical concentration, Monaural me for comm-Ion! and morass 3 PROTECTION FROM CONTAMINATION Points our ~10 (:05 COMMENTS wiping cloths properly stored clean and dry or In a sanmz-in-g solution 3 it Keep wiping cloths in a sanitizer between use Food-contact eu?om of 5 equipment clean 2 titanium-contact surfaces of utensils 8; equipment clean 1 26 Court St: Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 24 Proper equipmentlulensils storage. handling. to prevent contamination 2 25 Single service articles are from an approved source. are stored, handled. dispensed, used and disposed of in a manner that rewrite 1 25 No re?use of single service containers for food or chemical storage 1 Plummet-I WATER SUPPLY a DISPOSAL Points IN OUT NIO COS Water supply is from an approved source and water supply is suf?cient for the operations intended 3 1 COMMENTS Sewage disposal approved Proper disposal of waste water in approved disposalfacilities (ie slop sinks) 3 )1 WT IN OUT HID MIA COS COMMENTS Location. installation, maintenance (is dripping faucets, leaking pipes. improperly wasting pipes) 2 I Plumbing Installed preventing cross connection. back siphonage. back?ow 3 Adequate handwashing facilities, easily accessible. designed. installed 3 32 Torlul laciliias properly constructed. soil cloning din-ore. ?stums In goon repair. supplied ivilh mg and towel: dispensers! nano- dm?ng devices. cleaned. covered sanitary dispoal reoeplicle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airbome- and are 4 1 4 from food process-rig and storage areas 2 FACILITY AND GROUNDS Points IN CIUT HID NM C05 Suf?ceint covered trash recepticles present in adequate number, leak proof. insectlrodent proof. emptied with adequate frequency, clean 2 Outside premises are free from trash. etc . free of harborages. breeding places for rodents. insects. and other pests Outside areas (roads. yards. disposal swlams) provide adequate drainage and do not constitute a source of contamination Controlled incineration 2 it Doors, Windows. and other openings are protected to eliminate entry by Insects. No evidence of pests present Mouse droppings and dead mouse in trap in office by food storage Cold air flow by 3 3 the wall in the corner by the covered column PWTIPIB FLOORS. WALLS a. CEILINGS Points IN OUT HID MIA COS COMMENTS Proper floor construction, proper floor covering installed, ?oors graded with drained as required, floor and wall juncture covered Floors in good repair and clean Dustless cleaning methods used as needed 1 37 Walls. ceilings. attached equipment. properly constructed. good repair. clean Wall a ceiling surfaces as required Dustless 1 claim-lg method: used as needed Adequate lighting provided for suf?cient candle light Fixtures properly shielded or use of shatter prood bulbs 1 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust. andlor other airborne substances 1 40 Locker rooms. employee changing areas, provided. located to prevent contamination of production areas. and used for storage of employee personal items properly equipped and property ventilated Dressing rooms are maintained in good physical repair. 1 1 41 Insecticides and rodenticides are used and stored so as to prevent contamination of food items Detergents. sanitizers and other cleaning supplies are used in a safe. effective manner Hazardous materials are kept in their original containers and stored separate from raw materials 3 42 Premises maintained free of litter. unnecesary items and articles. cleaning maintenance equipment properly stored. 1 l: Separation of maintenance rooms and equipment, laundry facilities by partition 1 Salim properly stored 1 Photon-ans RESPONSIBLE PERSON IN CHARGE Points IN OUT MIA COS COMMENTS Certi?ed Food Protection Manager 3 PIC is knowledgeable and understands sanitary controls demonstrates competence 2 ITEM HIGHLY SUSCEPTABLE POPULATIDNS Points IN OUT NH) MIA C05 47 Pastuerized foods used; prohibited foods not Offered 1 3 ll! ITEM FOODICOLOR ADDITIVES PointFood additiveszapproved and properly used 3 I 1 ITEM mun-pin EQUIPMENT AND UTENSILS Points IN OUT N10 :05 COMMENTS 45 All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food products 2 50 Instruments and controls used for measuring. regulating. or recording temperature. pH. acidity. water activity. or other conditions are accurate and adequately maintained 1 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Z-tallbratlon records for eqmpment, thermometers, and other deVIces for control at hazards are accurate and adequately maintained Photograph: LICENSURE IPointsI IN I OUT N/o NIA COS COMMENTS Firm is currently licensed by the regulatory authority having jurisdiction CON-FORMANC-E WITH APPROVED PROCEDURES (WT 1 pt for all) OUT W0 NM COS Have training annuallv but never printed Written heal policy W1. E013. Lei-cal EDI-I ReimLtrion Procedures for responding to vomiting dian'heal events ITEM ?mind's RECORDS IPoinej IN Lauri mo] I cos COMMENTS 54 Requnfed records viva-ll tile. carat-tn destructionJime A1 a Public Health Control, required legs I 1 i ?l_x Photographs ITEM RECORD CHECKLIST Water quality and supply records, grease trap cleaning record, ansul system cleaning records and tags current, Fire last done in 2014 Employee training records It Temperature control records Equipment monitoring and maintenance records Calibration records Sanitation records Required Logs; Time as a Public Health Control, Receiving Temperature. parasite destruction. Employee Health records Pest control records Variance request and approval, Time as a Public Health Control Procedure Inspection records (e incoming product, facil y. production area) ITEMS OBSERVED Critical Items Observed (Primary. Primary Found-lion) Non-Critical Items Observed (Primary Foundation, Com) Total Non-Compliant Observations Score: 87 IN: In Compliance OUT: Out of Compliance Not Observed Not Applicable COS: Corrected on Sight Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report. when signed below or delivered using electronic mail, by 3 Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: PCIS prepares pasta, nachos, rice, and send them over in hot boxes. Spoke with manager about creating a temperature receiving log for foods sent in hot or cold boxes prepared at another location Will need certificates for anti choking traininng posted, also post allergen training certificates, post vomiting and diahrreal event procedure, post employee sickness policy for reportable diseases. The massachusetts new retail food regulations are avallbale on line, some of the new procedures can be taken right. from the code. Workers were dressed neatly and clean uniforms, observed using good hygienic practices, facility clean. Critical items are equipment issues and facility issues. 26 Court St. Plymouth, MA 02360 Tel: 503-747?1620, Extension 10118 Diagrams: Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 503-747-1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACIUTY NAME: Manon-let Elementary In: 1:40 Iout'fl Fondborne Illne risk factors are important practices or procedures Mdress: 'r'n Manome Point Rd Inspection by: Marcia Lee as the most prevalent contributing factors of foodborne Phone: 508-330-0330 Signature: illness and/or injury. Public health interventions are control measures Last Imp, Date: 5.19.17 Received by: used to prevent such foodborne illness andror il'lwnp. Purpose of Inspection: routine Signature: Types of Inspection: Routine, Re-lnspection, HACCP, Pre-Operation, Type of Establishment: elementary school Email: Suspect Iltness, Complaint. or Other Llcameifl?ermlt Number: Not posted Business Email: SOURCE OF FOOD Points IN OUT NIO MIA CBS ITEM Code COMMENYS Approved source for food, water.and ice: received at proper temperatures, wholesome, 1 nonadulterated, in good condition, records available. 53-201 11, 53?20211, ?3?202,15 3 590 003W Items must be properly date marking disposition: date prepared, date frozen. date thawed. 2 -iratlo' data. ?3~501 16. ?3-501 17 2 It 590 007 ITEM FOOD PROTECTION Points IN OUT NIO NIA COS ITEM Code 3 Potemralty hazardous food meets temperature requrrementa dunng storage, preparation, 3 cooking, cooling, reheating, holding, display, service, and transportation ?3?401 11, 590 003 501.14, 53-403 11_ ?3?501 16_ 53-501 19 3 3 Fact: int he only cold unit were above 41F Log does not indicae a pas: proclaim- 4 Adequate facilrIIes to maintain product temperature, thermometers prowded 3 3 4 590 004 ?ngernails ?mil-mi in the kitchen 5, Themrometers are present, conspicuously placed, accurate, calibrated, present 1 I. 5 590 003 5 Potenhally hazardous food 2 5 1 Proper disposition of returned, previoust served, reconditioned, and unsafe food ?34506 14Food protected during storage, preparation, display, service a transportation Food 3 containers stored otf ?oor Washing fruits and vegetables ?3-302 11, 53-304 11, 30415IAI. 53-306 131A) 3 590 003 p?pm: No bare hand contact with ready-to-eat foods, proper utensils used, or approved alternate 9 method properly followed ?3-301 hygienic practices, proper handwashing and glove changing observed ?2?301 11, ?2-301 12, ?2?301 14 3 Ir 590 003(0) In use toad dispensing uiunurls properly stored 1 10 590 005 Juror?? EMPLOVEE HEALTH Point: IN OUT NIO C05 ITEM Code COMMENTS Management awareness; Proper use of reporting, proper restriction exclusion for 11 reportable diseases ?2-201 11, ?2-201 12, 52-201 13 No discharge from eyes. nose. or 590 002 mouth observed ?2?401 12 3 12 Proper eating, tasting. drinking Smoking restricted ?2?401 11, ?3-301 12 12 590 003 3 II 5qu 007 Proper hair and board ronlrarnlc are worn correctly. cilan Intel-Ian wtures. and 13 aprons, proper glove use 1 )r 590 EQUIPMENT a. UTENSILS: Points IN OUT NIO cos ITEM Code COMMENTS Food-contact surfaces designed, constructed, maintained, installed, located 2 14 590 any Nonfood-contact surfaces designed, constructed, maintained. installed, located 1 15 590 007 15 Dishwashing facilities approved design, adequately constructed, maintained, installed, 15 located 2 2 590 004 17 Proper chemical test kits, measuring devices for ph. thermal strips, and logs are present 17 590 004 Temperature and psi gauges are accurate 4-501 113 1 log cheap for chemical sanitation but not tilled out Tablewares and Equipment is pro-flushed, scraped, and soaked priorto cleaning 13 590 004 Wash and nose water is clean, and at proper temperature 2 19 590 005 Sanrrizabon rinse (not water - chemical). Proper sanitization 01 food contact surfaces through temperature, chemical concentration, exposure time for equipment and utensils ?4~501 111- 59? 20 3 20 ITEM PROTECTION FROM CONTAMINATION Points IN OUT ITE Code .CCIMMEHIS WIpIng cloths properly stored clean and dry or in a sanitizing solution 21 590.003 2 590.004 Food?contaot surfaces of utensils equipment clean. ?4-602.11 2 22 530 004 Nonfood-contact surfaces of utensils a equipment clean 1 23 590 004 Proper storage, handling, to prevent contamination 1 24 590 004 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL INSPECTION FORM Minot? PROTECTION FROM CONTAMINATION Points IN OUT NIO NIA cost It ITE .Code COMMENTS Single mot-loo amt-HM are from an approved serum. are stored. handled. also-onsets. U536 25 590 004 and disoosed of in a manner that prevents corltamination No re-use of single service containers for food or chemical storage. 1 26 590 004 ITEM "remnants WATER SUPPLY DISPOSAL Points IN OUT N/o NIA cos it ITE Code COMMENTS 27 Water supply is from an approved source and water supply is suf?cient for the operations Int: 3 27 59o nos 28 Sewage disposal approved Proper disposal of waste water in approved disposalfacilities (ie 23 590 ODS slop sinks) 3 ITEM WT IN OUT NIO NIA COS ITE Code 29 Location. installation. maintenance tie dripping faucets. Ieaklng plpes. Improperly 1 29 55m 005 CDMMENTS 30 Plumbing installed preventing cross connection. back siphonage, back?owAdequate funnies. early accessible. designed. WM. $402.12 31 590 005 3 3; Toilet tncrirtraa- properly salt closing doors. Futures In good repair. supplied with 32 map and lei-vols In dragons-oral hand-dam don-roan. Gounod. covered oamtd?l drapes] bandwash signage present Toilet facilities have self-closing doors and doors do 590 006 not open unto areas Mien: load as exposed to airborne contamination and are adequately 590 005 separated from food processing and storage areas 2 mule IFACILITY AND GROUNDS Polnts IN OUT N10 NIA COS ITE Code 33 Suf?ceint covered trash recepticles present in adequate number. leak proof, insectlrodent 33 590 005 roof. emotie_d with adequate Frequency. ole?an 34 Outside premises are free from trash, etc . tree of harborages. breedlng places for rodents. 34 insects, and other pests Outside areas (roads. yards. disposal systems) provide adequate 590 006 drainage and do not constitute a source of contamination Controlled incineration 2 35 Doors. windows. and other are protected to eliminate entry by insects, 35 590 006 No Width-M0 ol poets present. 3 ?Warrant-s FLOORS, WALLS 8. CEILINGS Points IN OUT NIO NIA COS ITEM Code COMMENTS 36 Proper floor construction. pincer floor cove-mg Installed. Floors graded with drained as 35 required. floor and wall Iuncturo tavern-d Floors in good repair and clean. Dusttess cleaning 590.005 mutated: used as needed 1 Watts. ceilings. attached neuron-Ia I'll. property oomlluotod, good repair. clean Wait a ceiling 37 urinates as requlrod. Duration chum-lg mall-node used needed. 1 37 590 006 33 Adequate lighting provided for sufficient candle light Fixtures property shielded or use of 33 590 005 shatter orood bulbs 1 I 39 quality and ventilation are adequate to remove excessrve heat for equrpment and rooms 39 590 004 and orevent contamination by dust. andr?or other airborne substances. 1 1 HO tag on hood. 40 40 Locker rooms. employee dlangmg areas. provided, located to prevent contamination of 5 no product-on ewes. rind used lor otorono of emotoyoo pom-one! darn: property equipped and 9 4 property ventilated. Dressing room: are mam'lainm in good physical repaIL 1 41 Insecticides and rodenticides are used and stored so as to prevent contamination of food 41 items Detergents. sanitizers and other cleaning supplies are used in a safe. effective 5% 007 manner. Hazardous maten'als are kept in their original containers and stored separate from :Iorav bottle pink solution not labeled to Identify content tested and no active sanitizer raw materials ?7-202.12. ?7?203 11. {57-101 11. ?7-201.11 3 1.- w-r'i found 42 Promotes maintained free of litter. unnecesary items and articles. cleaning maintenance 42 590 006 equipment pnepertg,I stole-d. 1 Seperation of maintenance rooms and equipment. laundry facilities by partition. 1 43 590 004 Soiled linens properly stored 1 44 590 904 HEM Muir!? RESPONSIBLE PERSON IN CHARGE Foil-Its IN OUT NIO NIA ICOS Code COMMENTS 45 Certi?ed Food Protection Manager 3 45 590 no): Karla Sheehan 15-305mm parapresent. knowledgeable. understands sanitary controls, demonstrates 45 550 no; knowledge, performs duties 52-10111 3 590 A 5 26 Court St. Plymouth. MA 02360 Tel: 508-747-1520, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM HIGHLY POPULATIONS Points IN OUT NIO NIA COS ITEM Code 47 Peetuerized foods used; prohibited foods not offered ?3?801 11 47 3 590 003 FOGDJCOLOR mom-res Points IN OUT NIA COS ITEM Code Food additivee:approved and properly used ?3?202 12 2 48 590 003 mil-W EQUIPMENT AND Points IN OUT Njo cos ITEM Code All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to 49 590 004 avoid oomnaimoffood products-54402.11 2 It 50 trutrurnordaand cadrobuaod ion mun; moat-3'9. or I'd-carding tumour-.1. pr": In?nity. willy 50 activity. or other conditions are accurate and adequately maintained and calibrated 590 004 1 I: Molluskan Shellfish Tanks maintained, tested, and logs kept 1 51 590 004 ITEM WWI HEALTH PROCEDURES Point: IN OUT NIO NIA CD5 ITE Code COMMENTS 52 Pt Procedures for responding to vomiting diarrhea] events ?2-501.11 1 1 52 590 002 ITEM CONSUMER ADVISORY POSTED Points IN OUT Nlo NIA cos ITEM Code COMMENTS Constant: Advisory Posted. ?3-603.ll 1 I 53 590 003 Mums-anus specw. PROCESS-4E5 Points IN OUT NIO NIA cos ITEM Code Required records available; shellstock tags. parasite destruction.Time As a Public Health 54 59:1 003 Control, reouired logs. ?3?203 12. ?_3~402 11. ?_3402 12. ?_3~202 18 3 I Co Easine- with ramme- ialiaod' ?ts-16.1.12, 55-302. :4 2 a 55 $90 CUNFOHMAMCE WITH AanovED PROCEDURES Points IN OUT Nlo NIA cos rtEM. Code COMMENTS Alter en Certificate I 59:! til-Al Karla Shannan March uozd 590 011 (A) No certificate Local BOH Regulation . local no one presently IS chan?rhojmam trap and IDEEIHB per lag Firm is currently licensed by the regulatory authority havingjurisdiction local RECORD CHECKLIST ITEM Code COMMENTS Water quality and supply records. grease trap cleaning record. ansul system cleaning records and tans current. Fire extinouisher [ads current Employee training records 3.: Temperature control remrds Equipment monitoring and records 3: Calibration records Sanitation records 1: Required Logs; Time as a Public Health Control. Receiving Temperature. parasite . 590.008 destruction Pest control remrds Variance request and approval. Time as a Public Health Control Procedure tr 590.003?) Inspection records (a incoming product. facility. production area) 3: ITEMS OBSERVED IN: In Compliance In Red Risk Factors Oboerved {Priority} pls. Dad noted 3 Out of Compliance In Blue Good Reign Prac?ges Observed {Priority Foundation. Core} pts. Deducted 8 mo: Not Observed Total Non-Compliant Observations total points deducted 11 Not Applicable SCORE: 39 C05: Corrected on 'Vloiations cited must be corroded within the time frames in section 8405.11 or in dates otherwise written in the report. R: Repeat Violation 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM OFFICIAL ORDER FOR CORRECHON: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. ADDITIONAL NOTES: Was escorted by maintenance, worker had just left, no meals were present a time of inspection. Will reurn during lunch to observe and temp food. Temperatures Taken: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 1011B Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM mum NAME: . Mount Pleasant Elementary In: 9:30 [Out I I 5/17/19 Fucdbornu Illn 05:: risk factors are Important practices or procedures Address: Inspection by: identi?ed as the most prevalent contributing factors of foodborne Phone: Signature: illness and/or injury. Public health interventions are control measures Last Insp. Date: unknown Received by: used to prove nt such foodborne illness and/or Injury. Purpose of Inspection: ?routine Signature: Types of Inspection: Routine. RL-rl nspectlon. PIE-Operatic n. Type of Establishment: school Email: Suspect Illness, COMPIBIHL or Other Licenml'Puml?t Number: none lBusiness Email: SOURCE OF FOOD Point! IN OUT NIO NIA COSI ITEM Code COMMENTS Pawn: more for boo, wmam ice; received at prop-er temperance. whololomo. 1 halite-1mm. In good condition. records available. {gs-201.11, {51-202. l1. ?320? 15 3 at 590 003W Items must be properly deco rnadiing a disposition: date prepared. date frozen. date thawed. . mum mm. ?35u1.1a. gas-501 17 2 590 00? FOOD PROTECTION IN OUT NIA COS Code COMMENTS Potentially hazardous food meets temperature requuements during storage. preparation, 3 3 cooking, moling. reheating. holding. display. service. and transpomtlon ?3?401 11Adequate facilities to maintain product temperature. thermometers provided 1 4 590 004 5 Thermometers are present. conspicuously placed. accurate. calibrated. present 1 5 590 003 5 Potentially hazardous food properly thawed 5 7 Proper disposition of returned. previously served. reconditioned. and unsafe food ?3-306 14. 2 7 590 003 3 Food protected ounng storage. preparation. display. service anamportation Food conarners 3 stored off?oor Washing fruits and vegetables ?3-302 11, 53-30411ppm: No bare hand contact with ready-to?eat foods, proper utensils used. or approved alternate 9 method properly followed. ?301 hygienic practices. proper handweshing and glove changing observed 11. 52-301 12, ?2-301 14 3 590 003m) in use food dispensing Moro-ii:- property awed 1 10 590 003 EMPLOYEE HEALTH Points IN 0 UT WA CDSI ITEM Code COM MEHTS Managemem awareness; Proper use of reporting, proper exclusron for 11 reportable diseases ?2-201 11. ?2-201 12. ?2?201 13 No discharge from eyes. nose. or 590 002 mouth observed. ?2?401 12 3 12 Proper eating. tasting. drinking. Smoking restricted ?2-401 11, 53-301 12 12 550 003 3 5'90 007 13 roper Mir a beard restraints are worn correc y. a can unI arms. :cnen wnries, and 13 aprons, proper glove use 1 590 002 EQUIPMENT 5 DESIGN.CONSTRUCTION 8. INSTALLATION Points In our Mo MIA cos m: Code CUM ?Ems Food-contact surtaces designed, constructed, maintained. installed. loc-aled 2 14 590 m7 Nonfood-oontact surfaces designed, constructed, maintained, installed, loated 1 15 599007 16 Dishwashing facilities approved design. adequately constructed. maintained. installed. lonled 15 2 590 004 Proper chemical tat kits. measuring devices for ph. thermal strips. and logs are presenl 17 590 004 gunmencmm $501.1? 1 18 Tablewares and Equipment is pro-?ushed. scaped, and soaked prior to cleaning 13 1 590 004 Wash and nnse water Is clean. and at proper temperature 2 19 590 005 Sanitization rinse (hot water chemical) Proper sanitization of food contact surfaces through temperature. chemical concentration. exposure time for equipment and utersils 554?501 111? 59? 3 I 20 PROTECTION FROII CONTAMINATION Points IN OUT N10 NIA COS Code COMMENTS ole?n propuriy snared clan and dry or In a mm?rIz-r-n whit-3n 21 590.003 2 590.004 Food?comet surfaces of ?united adupmu'rl dart ?a?002.11 2 22 we: 01.: Noticed-contact surfaces of utensils II equipment clan. 1 13 590.004: Proper equipment/utensils storage, handling, to prevent contamination. 1 24 590 004 26 Court St Plymouth, MA 02360 Tel: 508-747?1620. Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM WW FROII CONTAMINATION Point: IN OUT COS ITEM Cod: COMHENTS Sn?qiu new? article: are lrom :tl'l source, on: storm, Pundit-ti, dispersed. mod and 25 590 004 disposed at in a manner prevents out . 1 No rue-tee 0! angle service nonunion: For loci! or chum-411 storage 1 26 590 004 WATER SUPPLY DISPOSAL Points IN OUT NID ITEM Code COMMENTS ater supply Is from an approved source and water supply Is sufficient for the operations men 3 I 27 590 005 Sewage disposal appioved Propel chap-Mill olwantewmm In waved {no 28 590 005 slop sinks: 3 IT with WT IN OUT NIO NIA COS ITEM Code Location, installation, maintenance (ie dripping faucets. leaking pipa. improperly wasting pipe- 1 29 590 005 COMMENTS 3,0 Plumbing installed preventing cross connection. back siphonage. backllow. 2 30 590 005 31 Adeqmte handwesrung faculties. ees?y accessmle. de5igrled. Installed 55-202 Toilet facilities: properly constructed. self closing doors. ?xtures in good repair, supplied with 32 soap and towels in dispensers! hand-drying devices. cleaned, covered sanitary dispoal reoepticle, handwash signage present Toilet facilities have self-closing doors and doors do 59!) DOB not open into eras where food is exposed to airborne con?mination and are adequately 590 005 separated from food processing and storage eras 2 ITEM mum FACILITY AND GROUNDS Point: IN OUT NIB MIA COS HEM Code 33 Suf?ceint covered trash recepticles present in adequate number, proof. insect/rodent 33 590 005 proof. emptied with adeuuate frequency. 2 34 Pt: Outside premises are free from trash. Etc . free of harborages, breeding places for rodents, 34 insects. and other pests Outside areas (roads. yards, disposal systems) provide adequate 590 006 drainage and do not constitute a source of contamimtion Controlled incineration 2 ii: 35 5 Doors, windows, and other openings are protected to eliminate entry by insects, 35 . 590 006 No eVIdence of nests present 3 {rm FLOORS. WALLS 8- CEILINGS Points IN OUT NIO NIA COS ITEM Code COMMENTS 36 Proper ?oor NWDIL proper ?oor covering manned. ?oor! granted with dmlnad 3: 35 required, ?oor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 006 mahods used as needed 1 Walls, ceilings. amched eqUIpmem, properly constructed, good repair. clan Wall ceiling 37 surfaces as required Dustless cleaning methods used as needed 1 37 590 006 3g Adequate lighting prowded for sutTIcient candle light Fixtures property shielded or use of 33 590 005 shaner mod bulbs 1 1w qunhry and ventilation are ode-quate- to remain: use-semi: hunt [or bowl-Intent and room: 39 and prevent contamination by dust, andlor other airborne substances 590 004 1 40 Locker rooms. employee changing areas, provided, located to prevent contamination of 5 4 production areas, and used for storage of employee personal items properly equipped and 5? 0? properly ventilated Dressing rooms are maintained in good physical repair. 1 41 41 Insecticides and rodentioides are used and stored so as to prevent contamination of food items Detergents. sanitizers and other dening supplies are used in a safe. effective manner 590 307 Hazardous materials are kept in their original containers and stored separate from raw materials. ?7-202.12. 57-203 11. ?7-101.11. 57-201 11 3 42 PremIsee maintained free of litter, unnecesary items and articles. cleaning maintenance 42 5 equipment properly stored 1 90 006 43 Seperation of maintenance rooms and equipment, laundry facilities by partition 1 43 590 004 Soiled linens properly stored 1 44 550 004 um RESPONSIBLE CHARGE Points Code .15 Certified Food Protection Manager ?2-102 12mpresent, knowledgeable, understands sanitary controls, demonstrates 45 5.39 no; knowledge, performs duties 52-10311 3 sac no; A a 26 Court St. Plymouth. MA 02360 Tel: 508?747?1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM HIGHLY SUSCEPTABLE POPULATIONS Pol-n13 IN HID NIA COS ITEM Code Famed foo-d: mod; prolibl'lm food:- not ol'Iumd M1. 1 47 3 55:3 mm FODDJEOLDR incints] IN our MID Nina. cos ITEM Code 43 Food mailman md properly mud $12502ITEM AND UTENSILS Paints IN UUT COS ITE Code COMMENTS 49 All mm and MUM are denim and united a! ml: that are Ire-quail ?ugh 4? avoid mrlamim?on 0116?: products. ?4~w2 I ?l 2 50 Pf Ina-vurnana and controls um ?94 menu-mg. reg-auto; or licensing acid-Ir. water 50 ash-1y or other conditions are accurate and adequately maintained and calibraled 5-9-0005 1 51 Hahn-Jan Shellfish Tanks maintained, lasted and logs kept 1 51 moo: HEM mason-Ho: PROCEDURES Point IN OUT NIO NIA COS Code COMMENTS Procedures {or responding to vomiting 5: dim-heal events. ?2-S?i i i 1 52 590002 CONSUMER ADVISORY POSTED Points IN OUT Nlo COS 3 Code COMMENTS 53 Consumer Advisory Posted ?3?603.l 1 I 53 590 003 SPECIAL PROCESSES Point: IN OUT MD NIA COS ITEM Code 54 Required records available; shellstock tags, parasite destruction,TirrIe As a Public Health 59:1003 Control. required logs ?3-203.12. 53-402 11. 53402.12. 53-20248 3 Com line: with Italian 'alizod til-Hull. ?aha-Jul.? 1? I 55 593 995?? CONFORMANCE WITH APPROVED PROCEDURES Polnl's IN OUT NIA COS ITEM Code COMMENTS It SWELHAI :It ED 5 Local 50H ulatlon Foul Firm is currently licensed by the regulatory authority having jurisdiction )1 Ieal RECORD CHECKLIST ITEM Code COMMENTS Water quality and suppty rem-Ida, grease trap cleomrvq mourn, afoul syslern claiming records and tags current Fire extinguisher tags current I Employee [raining records control moors-1. Equipment monitoring and maintemnce records It Calibration records Sanitation records Required Logs; TIme as a Public Halth Control, Receiving Temperature. parasite 590 m5 destruction Pest control records Variance request and approval, Time as a Public Health Control Procedure I: 590 003?} Inspection records (e . incoming product. facility, production ara) ITEMS OBSERVED In Compliance In Red Risk Factors Observed {Priority} p15. Deducted 0 OUT: Out of Compliance In Blue Good Retail Practices Observed {grimly Foundation. Core} pls. Oeductod 0 WC: Not Observed Total Non-Compliant Observations total points deducted Not Applicable SCORE: 100 C05: Corrected on Sight 'Violations cited must be corrected within the time frames in section 84105.11 or in dates otheniuise written in the rap on. R: Repeat Violation 26 Court St. Plymouth, MA 02360 Tel: 508?747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by 3 Plymouth Public Health Department inspector or an agent constitutes an order ofthe Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit a nd cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Temperatures Taken: ADDITIONAL NOTES: Not operational. In process of demolition. No longer a school. 26 Court St. Plymouth, MA 02360 Tel: 508-747-1629, Extension 10118 THE COMMONWEALTH OF MASSACHUSETTS I [aim Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT TOWN OR CITY OF Name e?ofD eration of Ins ection I {xi [Tm Food Service Routine [Iaii Risk Retail El Re-inspection Address Cad Si" 4 (Lori-E? Residential Kitchen Previous Inspection Mobile Date: Level Telephone {Lax} - 3?0 HACCP Caterer Suspect Illness CI a a - 0 . emporary Pre-operation Tom on of pi timer UM . Person in Charge (PIC) IO. i 1 Time Bed Breakfast General Complaint Ar 4 - In: Permit No. EIEI 12. Prevention of Contamination from Hands El 13. Hanriwash Facilities PROTECTION FROM CHEMICALS SN Hi D14. Approved Food or Color Additive D15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) Cooking Temperatures Rehee?ng CI 7. Conformance with Approved ProceduresiHACCP Plans Cooling PROTECTION FROM CONTAMINATION 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing Each violati checked requires an explanation on the narrative page(s) and a citation of specific provision(s} action as determiled by the Board of Health. ?mg? Awa'eness 590-009(3) EMPLOYEE HEALTH '7 4. Food and Water from Approved Source 9 (JP 19. Hot and Cold Holding El 8. 5P . z? Swede] i?I violated. .I- I 553111, ?C?r . Calf! Non-compliance withReporting of Diseases by Food Employee and 5. ReceivingiCondition Ugnuti m-yi 11? Jutngocid-tia [315' CI 20. Time As a Public Health Control consumes ADVISORY - . El HACCP Inspector K?i? Out: Other Violations Related?to Food borne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) \Violations marked may pose an imminent health hazard and require immediate corrective (fr/75bit?? FOODL ROTECTION A AGEMENT El 1. PIC Assigned I Knowledgeable I Duties El 3. Personnel with Infections RestrictediExciuded FROM APPROVED sounce I - - 7?15?" CI 6. TagsIFiecordsinccureel:r oi ingredient Statements 17REQUIREMENTS FOR HIGHLY SUSCEPTIBLE FOPULATIONS 21. Food and Food Preparation for 22. Posting of Consumer Advi co.- acme 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board Ith. 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Low elm: 0 ?30 Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: Print Inspector?s Signature: (ii/(L (2 Karen (pom: i .. Signature: Print KCAVIQ heeL'ILi/I FORM 734A AMSULKIN CO CHARLESTOWN MA - ?3 i Violations Related to Foodbome Illness interventions and Risk Factors (Red items 1-22) FOOD PROTECHON MANAGEMENT PROTECTION FROM CONTAMINATION Cross-contamination [1 590.003 LA) Assignment of Responsibility? r 59000303) Demonstration of Knowledge? 2403.11 Person in charge - duties EMPLOYEE HEALTH Responsibility of the person in charge to require reporting by food employees and applicants* 590.0030?) Responsibility Of A Food Emplyee 0r An Applicant To Report To The Person In Charge* Reporting by Person in Charge* I3 Exclusions and Restriction_s?_Ir 59000303) Removal of Exclusions and Restrictions FOOD FROM APPROVED SOURCE l4 Food and Water From Regulated Sources Raw Animal Foods Separated from Cooked and RTE Foods" Contamination lion! Raw ingredients 3-302.1 Raw Animal Foods Separated from Each Other" Contamination item the Environment Food Protection" 3-302. 15 Washing Fruits and Vegetables? 3-304.11 Food Contact with Equipment and Utensiis" Contamination from the Consumer Returned Food and Reserviee of Food??r Dispoeidon ofAdulterated or Contaminated Food 3-701.ll Discardin or Reconditioning Unsafe Food" I 9 Food Contact Surfaces Compliance with Food Law" 3-201.12 Food in a Hermetically Sealed Container?r 3-201.13 Fluid Milk and Milk Products" 3-202. 1 3 Shell Eggs?r 3-202.l4 Eggs and Milk Products, Pasteurized" 3-202.16 Ice Made From Potable Drinking Water" 5-101.ll Drinking Water from an Approved System* Bottled Drinking Water" Water Meets Standards in 310 CMR 22.0" 3-201.l4 Fish and Recreationally Caught Mollusean Shell?sh* 3-201.15 Molluscan Shell?sh from NSSP Listed Sources" Gameend RegulatoryAutirority 3-202.18 Shellstock Identi?cation Present* Wild Mushrooms* 3-201.? Game Animals" I 5 RecelenQIConrlItlon 3-202. 1 I PI-IFs Received at Proper Temperatures* 3-202 .1 5 Package Irggrity" 3-101.11 Food Safe and Unadulterated* 6 Tagsl?ecortls: Shelletock 3-202.18 Shellstock Identi?cation" 3-203.12 Shellstock Identi?cation Maintained* Ta?ecords: Fish Products 3402.11 Parasite Destruction? 3402.12 Records, Creation and Retention?r 590.0040; Labeling of tngretilnnla' Conformance with Approved Procedures Plane 3-502.ll Specialized Processing Methods? 3-502.12 Reduced oxygen peak-59g? criteria? 8403.12 Conformance with Approved Procedures?r Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. Manual War-mashing - Hot Water Sanitization Temperatures" 4-501.112 Mechanical Warcwashiog - Hot Water Sanitization Temperatures" 4501.114 Chemical Sanitization - temp, pH. concentration and hardness* Equipment Food Contact Surfaces and Utensils Clean* 4-602.? Cleaning Frequency ofiquipment Food- Contact Surfaces and Utensils" 4402.11 Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment* 4-703.ll Methods of Sanin'zation - Hot Water and Chemical" [10 Proper. Adequate 2-301.ll Clean Condition - Hands and Arms? r 2-301.12 Cleaning Procedure* 2-301.14 When to Wash" Good Hygienic Practlcea 2401.11 Eating, Drinking or Using Tobacco" 2401.12 Discharges from the Eyes, Nose and Mouth?Ir 3-301.12 Preventing Contamination When Tas?ng*_ Prevention of Contamination from Hands 59000403) Preventing Contamination from Employees* [13 Handmeh Facilities Conveniently Located and Accessible 5-203.l 1 Numbers and Capacities? 5-204. 11 Location and Placement" 5-205.11 Operation and Maintainanee Supplied with Soap and Hand Drying Devices 6-301.ll Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name eofo oration emf! t? IN CUI- kit/??1 3 CK i Service I %outin?es EC to" Risk I Retail Residential Kitchen Address Re-ins ectIon Previous inspection Date: Level Telephone 51.2? C) Mobile Pre-operation Caterer Suspect Illness Person Char PIC 1" Bed Breakfast General Com laint )ij CI 5" 3'11"" "Te EHACCP Inspector {4 (t Out: Permit No. L__IOther Each violatio?n checked requires an explanation on the narrative page(s) and a citation of specific provision(s) VlDIated. Non-compliance with: Violations Related to Foodborne Illness interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590-009 (F) El action as determined by the Board of Health. Awa'eness 590-009 ?63 EI Owner HACCP YIN emporary IUL?jvr?x?f? Fadi'x'xc'a- a FOOD PROTECTION MANAGEMENT 1. PIC Assigned!KnowledgeablelDuties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. 6. 7. PROTECTION FROM CONTAMINATION I: 8. 9. CI 10. Proper Adequate Handwashing Receivingl00ndition Tagisecordsl'Accuracy of Ingredient Statements Conformance with Approved ProcedureslHACCP Plans Food Contact Surfaces Cleaning and Sanitizing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 0 23. Managementand Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS D14, AppIOVed Food or CoiorAdditives D15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) 16. 17. 18. Cooking Temperatures Reheating Cochng D19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne illnesses Interventions and Risk Factors (Red items 1-22): Official Order for Correction: Based on an inspection today. the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: I Inspector [?I'int: l?lC's Signature: qty? ML Print: Jodi I?r: FORM 734A AM CHARLESTOWN MA Violations Related to Foodborne Illness Interventions and Risk Factors (Red items 1-22) FOOD PROTECTION MANAGEMENT 1 590.0030? Assignment of Responsibility" 59000303) Demonstration of Knowledge* 2403.11 Person in charge - duties EMPLOYEE HEALTH Responsibility of the person in charge to require reporting by food employees and app?Cants? 590.0030?) Responsibility Of A Food Emplyee Or An Applicant To Report To The Person In Charge." Reporting by Person in Charge* 590.0030?) Exclusions and Restrictions? 590.003fE) Removal of Exclusions and Restricrjons FOOD FROM APPROVED SOURCE [4 Food and Water From Regulated Sources Compliance with Food Law* 3-201.12 Food in a Hermetically Sealed Container* 3-201.l3 Fluid Milk and Milk Products? 3-202.13 Shell Eggs" 3-202. 14 Eggs and Milk Products. Pasteun'zed* 3-202. 16 Ice Made rorn Potable Drinking Water"r 5-101.11 Drinking Water from an Approved System" Bottled Drinking Water* 59000603) Water Meets Standards in 310 CMR 210* Shell?sh and Fish from an Approved Source 3-201.14 Fish and Recreationally Caught Molluscan Shell?sh* 3-201.15 Molluscan Shell?sh from NSSP Listed Sources* Game and Wild Mushrooms Approved by RegulatoryAtrthorlty 3-202.18 Shellstock Identi?cation Present* Wild Mushrooms" 3-201.? Game Animals* 3-202.1 1 PHFs Received at Proper Temperatures* 3-202.15 Package Integrity* 3-101.11 Food Safe and Unadulterated? Tagsi?ecords: Shellstock 3-202.18 Shellstock Identi?cation" 3-203.12 Shellstock Identi?cation Maintained" Tagsl?ecords: Fish Products 3402.11 Parasite Destruction? 3402.12 Records, Creation and Retention* 590.0040) Labeling of Ingredients? Conformance with Approved Procedures Plans 3-502.11 Specialized Processing Methods" 3602.12 Reduced oxygen packaging. aireria? 8403.12 Conformance with Approved Procedures* Denotes critical item In the Federal 1999 Food Code or 105 CMR 590.0110. PROTECTION FROM CONTAMINATION Cross-contamination Raw Animal Foods Separated from Cooked and RTE Foods" Contamination from Raw ingredients 3-302. 1 Raw Animal Foods Separated From Each Other* Contamination item the Environment Food Protection" 3-302.15 Washing Fruits and Vegetables* 3-304. 11 Food Contact with Equipment and Utensils* Contamination from the Consumer Returned Food and Reservice of Food" Disposition ol'Adulterated or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces [10 4-501.111 Manual Warcwashing - Hot Water Sanitization Temperatures* 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures* 4601.114 Chemical Sanitization - temp, pH, concentration and hardness" Equipment Food Contact Surfaces and Utensils Clean" 4-6021 1 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils? 4-702.1 1 Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate 2-301.11 Clean Condition - Hands and Arms* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* [11 2401.11 Good Hygienic Practices Eating, Drinking or Using T0bacco* 2401.12 Discharges from the Eyes, Nose and Mouth? 3-301.12 Preventing Contamination When Tasting* [12 Prevention of Contamination from Hands Preventing Contamination from Employees?r 13 5-203. 11 Conveniently Located andAccessihie Numbers and Capacities* 5-204. 11 Location and Placement* 5-205.11 Access?aility, Operation and Maintainance Supplied with Soap and Hand Drying Devi c9: 6-301.? Handwashing Cleanser. Availability 6-301.12 Hand Dryi_=ng Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF 7 I 4.51110.? bitEstablishment Name: Date: I I 15 7 Page: of Item Code -Cn?tical Item Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Wu?ir?gdf? [La-Hun; ?11 {mg 3'93? 119 7 i 5905 AM ?my; (1.4 pix-{ITC r(1/5 1/0 170 7; ML mL?{Jia ?pni?a gun," my}. ports?k3 C'r?hiup {3946. $2.41 Discussion With Person in Charge: Corrective Action Required: No Yes Cl Embargo Voluntary Disposal CI Voluntary Compliance Cl Re-inspection Scheduled Employee Restriction I Exclusion Emergency Suspension Emergency Closure Other: Form 734 8 AM. Sulkin (20., Boston, MA 3-501. l4(C) PHFs Received gt?Tempemtules Violations Related to Foodbomo Illness Interventions and Risk According to Law Cooled to Factors (Rod'ltems 1-22) (Cont) Within 4 Hours. 3-501.15 Cooling Methods for PI-Es PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 3-50l. l6(B) Cold PHFs Maintained at or below I 4l?l45? . . 3- 14 from Additives 3-501 . Hot PHFS Maintained at or above 15 Poisonous or Toxic l40?F 7-101." -Ori inal Roasts Held at or above Containers? Name I 20 Time as a Public Health Control 1.11 3-501.l9 Time as a Public Health Control" $202.11 and Use' 59000401) Variance Requirement 1 Toxic Containers Prohibitions? REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7.204.] I POPULATIONS (HSP) 21 3-80I .l Unpasteurized Pro-packaged Juices and Beverages with Warning Labels" - Criteria? 3-80? Use of Pasteurized Eggs? 7-2051 1 -7-206.1 Criteria' 3-801J Raw or Partially Cooked Animal Food and 7406.12 Rodent Bait Stations' Raw 13 Control and Unopened Food Package Not Reserved. Monitoring? CONSUMER ADVISORY CONTROLS I 22 3'50? Advisory Posted for Consumption of 16 Proper Cooking Temperatures for . Animal F??d5 That are Raw, Undercooked or Not Otherwise Processed to Eliminate Eggs- 3m - Pathogens.'mm' Eggs- Immediate 3-30113 Eg_grs Substitute for Raw She" Eggs" Comminuted Fish, Meats Game . Animals 15 sec. . SPECIAL REQUIREMENTS and 12] min" ViOla?onS 0f Section in 3401.1 1000) Rallies, Injected Meats - 15 sec. "mime and reSIdentlal Operations should be 3401. Poultry, Wild Game, Stuffed PHFS, debited the appropriate sections Stuf?ng Containing Fish. Meat. above if related to foodbome illness Poultry 0, 15 sec, - interventions and risk factors. Other 3.40:, Whole-muscle, Intact Beef Steaks 590.009 violations relating to good retail . 145.3,.- . practices should be debited under #29 3401.12; Raw Animal Foods Cooked in a Special Requirements. Microwave 3-40Ll All Other pups 1450p 15 sec. 1- RELA TED TO GOOD RE TAIL 17 Reheatlng for Hot Holding (Blue Items 23-30) 3-403. I PHFs 15 sec in Critical and non-critical violations. which do not relate to the - I . . foodborne illness interventions and risk factors listed above. can be 3403'! 1(3) Mlcrowave- 165? 2 Mlnute found in the following sections of the Food Code and 105 CMR Tim? . 590.000. 3-4011 Processed RTE Food - FC 140?!" 2 3-403. Remaining Unslieed Portions of Beef . Roasts? . - 4 18 Proper Cooling of PHFs Water. and Waste - 3-50l .l4(A) Cooling Cooked PHFs from _l40?F to Within 2 Hours and From to Within 4 Hours. Cooling PHFs Made From Ambient Temperature Ingredients to Within 4 l-Iours?I Denotes critical item in the federal I999 Food Code or 105 CMR 590.000. Poisonous or exit: 7 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: :Nathaniel Morton School In: I 1:15 [Out I [5,24,19 Fcedborne illness risl: factors are Important practices or procedures Address: 7 Lincoln Inspection by: tea identi?ed as the most prevalent contributing factors of foodborne Phone: 508?830?4320 Signature: PW illness and/or injury. Public health interventions are control measures Last lnsp. Date: 12.19.2017 Received by: Myahelle McNeill .. used to prevent such foodborne illness andfor Injury. Purpose ol inspection: routine Sagnature: KW Types Routine, Re-lnspection, HACCP, Pre?Operation, Type of Establishment: elementary School Email: :hmkeeozaeoe: M5N.COM Suspect Illness, Complaint, or Other Number: 2388, 676 lBusiness Email: SOURCE Point IN OUT NIO NIA COS ITE Code COMMENTS Appruvud source For load, wutm,a.nd Ice; facurvod at plupal' temperatures, whore-some, 1 normal Literals-:1. In good condition, records available. gal?201 11, 53-20211. $1202 15 3 5'30 003ml norm be prop-my unto marking a deposition: date prepared, onto froze-n, dam thawed, 2 ption date Wt 13' 2 590 007 Improper labeling use exp dates, ITEM FOOD PROTECTION Polnts Irv out we NM cos n'E .Eode COMMENTS 3 Potentially hazardous ioocl meets temperature requrrements during storage, preparation, 3 cooking, cooling, reheating, holding, display. service, and transportation ?3?401 11, 590 003 3 a tummy 1: 1135?- instructed workers not to anpaug units until the food service is :o'nn met: 4 Adequate facilities to maintain product temperature, thermometers provided 1 4 590 (ma 5 Thermometers an: pie-aunt. commonly placed. accurate. calibrated. arm?! 1 5 590 003 no stem thermometer for taking internal food temperatures. using an oven cooklng thermometer 5 Potentially hazardous food properly thawed 2 5 7 Proper disposition of retumeo, prevrousry served, reconditioned, and unsafe food ?3?306.14, 2 7 590 003 3 Food protected during storage, preparation, display, service 81 transportation Food 8 containers stored o? ?oor Washing fruits and vegetables ?3-302 11, 53-30411, 53- 304.151Al. 3 590 003 9 No bare hand contact with ready-to-eat foods, proper utensils used, or approved alternate 9 method properly followed 5301 hygienic practices, proper handwashing and glove changing observed 52-301 11, ?2-301 12, ?2?301 14 3 590 003m) 10 In use food dispensing utensils properly stored 1 10 590 L103 eupLovEE HEALTH Points IN ouT two urn cos n: .Code (OMMENTS 11 Management awareness: Proper use of reporting, proper restriction 8. exclusion for 11 reportable diseases ?2?201 11, ?2-201 12, ?2?201 .13 No discharge from eyes, nose, or 5'30 002 mouth observed. ?2?401 12 3 1t 12 PIC Proper eatlng, tasting, drinking Smoking restricted ?2?401 11, ?3?301 .and move changing aw Foo: .?nr spruce 13 ?roper air an- -ear- restraIn are worn cone ,6 aan unI ~rms, Kitchen wn es, and 13 aprons, proper glove use 1 1 590 002 no hair restraints EQUIPMENT 8- UTENSILS: DESIGN.CONSTRUCTTON 5 INSTALLATION Points IN NIO NIA COS ITE .Cade 14 Food-contact surfaces designed, maintained, installed, located 2 14 550 007 15 surfaces designed. constructed, maintained. Installed round 1 15 530 007 15 Dishwashing facilities approved design, adequately constructed, maintained, installed, 15 located 2 590 004 dishwash 150 178 temp at met 150. 17 Proper chemical test tats, measuring dances for ph, thermal strips, and logs are present 17 590 004 Temperature and psi gauges are accurate 4-501 113 1 1 no log Sheet. 13 Tablewares and Equipment is pro-flushed, scraped, ant:I soaked pn'orto cleaning 15 55? 004 1 Wash and rinse water is clean, and at proper temperature 2 )t 19 590 005 Sanitization nnae (hot water? chemrcar) Proper sanitization of food contact surfaces through temperature, chemical concentration, exposure time for equipment and utensils ?4-501 111- . "(At 590 E104 no setup For sanitizer forfood contact surfaces A good Item Is the smgle use sanItIzer whrte that 20 3 3 20 Ecolab stock since Ecolab is the prompt-r l-J' chemical products at the school - PROTECIFDN FROM Point: IN NID ITE Codi: COMMENTS WIpIng cloths properly stored clean and dry or in a sanitizing solution 21 590.003 2 1 590.004 Clair-s scieccn counter. Food?contact surfaces of utensils 5 equipment clean ?4-602 11 2 22 590 004 Nominee-contact cur-laces oi memes 8- equmonr drum 1 23 550 004 Proper equipmentr'utensils storage, handling, to prevent contamination 1 24 590 004 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM Pow-Imam PROTECTION FROM CONTAMINATION Point: IN OUT NID NIA lTEMdee COMMENTS 25 Single serVIce articles are from an approved source, are stored, handled, dispensed, used manner that prevents contamination 1 It 25 No re-use of single service containers for food or chemical storage. 1 25 590.004 ATER SUPPLY 8r DISPOSAL Palms IN OUT NIA COS ITE .Code COMMENTS War-1r In from an approved source and writer sup-133v I: sul'fIBIont tor Ina uporrdions ml: 3 )r 27 590 005 Sewage disposal approved. Proper disposal of waste water in approved disposalfacilities (ie 28 590 005 slop sinks). 3 PLUMBING WT IN OUT NIO NIA C05 ITEM Code Location. Insla?allcn, maintenance (Ie dripping faucets, lealcng pipes. Improperly wasting plpI 1 I: 29 590.005 COMMENTS Plumbing installed preventing cross connection. back siphonage. beek?owMemento handwashing facilities, accessible. desrgned, Installed 55-20212 31 590 005 3 pf; Toilet leciitlas propel? suit claim-g doors. futures in good repair. with 32 soap and Iowuts dispensary hand-drying demons, weaned. covmod oamlary diape al honor-rash signage present Toilet have sell-chiting doom and doors do 590 006 not upon Into areas more land is amend lo and are mmuninly 550 005 separated Irarn toe-cl pmasrrg and storage arena 2 FACILHT AND GROUNDS Points IN OUT NIO NIA COS ITEM Code Sui?oeint covered trash recepticles present in adequate number. leak proof. insectlrodent 33 590 005 woof. ram-tied with ade- ate frequency. clean 2 I: 34 Outside premises are Ire-I3 from trash. alc .llee DI harbor-egos. brawlng placed Iur rodents, 34 mode. and Dine! Pena Outside are-n [rs-11:. raids. dllposril provide adequate 590 006 drainage and do not constitum a source ol contamination Contro?ed Incineration 2 Doors, mmow-a, and mm: openings are protected lo ul-n-Iiriato entry 01 meals, as 590 nos No evidence of pests present 3 ITEM FLOORS. WALLS CEILINGS Points IN OUT NIA COS ITE Code DOM MENTS 35 Proper ?oor construction, proper ?oor covering Installed, ?oors graded with drained as 35 required, floor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 006 rnalhods used as needed 1 Walls, ceilings, attached equipment, properly constructed. good repair. clean Wall 8. ceiling 37 surfaces as required Dustless cleaning methods used as needed 1 37 590 006 33 Manuela lighting crowds-d for suit-cram candle Fixtures prup-mly molded or use of 33 590 Dos shatter prood bulbs 1 39 (3 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms 39 590 004 NH prevent contamination by dust, drrdior other aim-emu IutlB'tIlnce-e 1 40 40 Locker rooms. employee changing areas, provided, located to prevent contamination of 590 004 production areas. and used for storage of employee personal items properly equipped and property ventilated Dressing rooms are maintained in good physical repair, 1 1 41 41 quatentrary ammonia concentration and spray bottle exceeded 400 parts per million the paper Insecticides and rodenticidee are used and stored so as to prevent contamination started dri in offthe 3 er on another chart it exceeded 500 arts er million but is hi items. Detergents, sanitizers and other cleaning supplies are used in a safe, effective sag 007 pp manner. Hazardous mte?ab are kept in their original containers and stored separate from Ina-1 that based upon the color oithe strip Workers were not given instruction on how to dilute the raw materials. 57-202 12. 57-203 11. ?7-101 11, ?7?201 11 3 3 pro?t: a rest to tea! the rung-timer. 42 Premrses maintained tree of litter, unnecesary items and articles, cleaning maintenance 42 590 006 eduioment property stored. 1 It 4; Separation of maintenance rooms and equipment, laundry facilities by partition. 1 43 590 004 44 Soiled linens properly stored 1 44 530 004 [ram min-arms PERSON IN CHARGE Points IN our NIO NIA cos ITE Code com MENTS Certi?ed Food Protection Manager. 3 45 590 0qu N?i'tht'h: Mciitt-l' :euosaca. 3 2-321 (or Smith :jarrsolpresent. knowledgeable, understands sanitary controls, demonstrates 45 59,, 002 knowledge, performs duties. ?2?103.Court St. Plymouth, MA 02360 Tel: 508-747-1520, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM Mm!? HIGHLY SUSCEPTABLE POPULATIONS Pains IN OUT MIA COS ITE Code 47 Pastuerized foods used; prohibited foods not offered ?3?801.11 47 590 003 3 Writs FOODICOLOR ADDITIVES Points IN OUT HIO EDS ITE Code 43 Food additives:approvea and properly used ?3-202 12 2 48 590 003 lrrEM Writs EQUIPMENT AND UTENSILS Points IN OUT NIO NIA COS ITE Code COMMENTS All menstle and equipment are cleaned and sanitized at IntarVaIs that are frequent enough to as 590 004 and contamination alto-ed odocls ?ll?(rm. 11 2 5D Instruments and controls used tor measuring. regulating. or recording temperature. pH. eeloty? water 50 activity, or alter conditions are securele and adequately meirlleined and calibrated 590 004 1 51 Mollusken Shell?sh Tenle maintained. tested, and logs kept 1 51 590 004 ITEM more HEALTH PROCEDURES Point's our Nfo will cos ITE Code COMMENTS 52 Pf Procedures for responding to vomiting diarrhea] evens. 1 52 590 002 ITEM CONSUMER ADVISORY POSTED PoinB IN OUT NIA COS ITEM Code COMMENTS 53 Consumer Advisory Posted ?3-603. ll 1 I 53 590 003 ITEM SPECIAL PROCESSES Points IN OUT Ill/A COS ITEM Code Requtrecl records available; shenstock tags, parasite destruction,Tlme A5 a Public Health 54 590 003 Control, required logs. 53-203 12. 53402.11 ?3402 12. 53-202 18 3 1 Compliance with va?armefspecia?zed prooessfl-IACC?P. ?8-103.12. $3302.14 1 SS 3v? CONFORMANCE WITH APPROVED PROCEDURES Points IN OUT NIO NIA COS ITEM Code allelgcn Certificate 1 530 011(Al 'odi Nickerson, 2024 not here tools?.I no one else hat one Anti-Choking I Still D11 {Al 0.6. Local BOH Regulation - local Firm is currently licensed by the regulatory authority having jurisdiction local Photographs RECORD CHECKLIST ITEM Code COMMENTS Water quality and supply records, grease trap cleaning record, ansul system cleaning records and teas current Fire e_xtinouisher Ia_g? current Emplovee training records Temperature control records Equipment momtonnlg and instruction?: women 1.: Calibration records Sanitation records it Required Logs; Time as a Public Health Control, Receiving Temperature. parasite . 590 008 destruction Pest control records Variance request and approval. Time as a Public Health Control Procedure 550 ooaidl Inspection records (a incoming product, facility, production area) ITEMS OBSERVED IN: In Compliance In Red Risk Factors Observed {Priority} pts. Deductecl 12 our: cut of Compliance In Blue Good Retail Practices Observed (Priority Foundation. Col-o] pts. Ded ucted 4 No: Not Observed Total Non-Compliant Observations total points deducted 16 Not Applicable scone.- Bd cos: Corrected on Sight "ll'iofatlons cited must be corrected within the time frames in section 8405.11 or in dates othenllrise written in the report. R: Repeat Violation 26 Court St. Plymouth, MA 02360 Tel: 503-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar day-5 of receipt of this order. Temperatures Taken: ADDITIONAL NOTES: 26 Court St. Plymouth, MA 02360 Tel: 508-747-1520, Extension 10118 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Dat Tyg?ngerationis] fins action Cam?hw?ilhj Karim-culturi- UK ?79/ 91/! I7 Food Service I?i?outine I7 (Chi pad 9 0019 Risk Retail [:IRe-Inspection Level Residential Kitchen Previous Inspection Tele hone CD {o 3 t: Mobile Date: Owner TOLOM (gm HACCP YIN Temporary Pro-operation ,1 Caterer Suspect Illness Person in Charge (PIC) 63, Time Bed Breakfast General Complaint Ch Cf? In: HACCP Inspector {Ox/k0 AL Out: Permit No. UOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) Non-compliance with: Violations Related to Fooclhorne Illness Interventions and Risk Factors (Red Items) Anti-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tabacco 590-009IFI action as determined by the Board of Health. Allaigen Awafeness 590-009IG) Ell] 801D PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands . PIC Assi ned Knowled eablel Dot 5 .. . 'e 13. Handwash Faculities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS [:114. Approved Food or Color Additives Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) E) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedIExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition D16. Cooking Temperatures Reheating D18. Cooling Hot and Cold Holding 6. TagsIRecordsiAccuracy of Ingredient Statements 7. Conformance with Approved ProceduresIHACCP Plans PROTECTION FROM CONTAMINATION 19' [j 8. 20' TimeAs a Health Control . . . . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS El 9. Food Contact Surfaces Cleaning and I3 21' Food and Food Preparation for HSP CI 10. ProperAdequate Handwashing . . . CONSUMER ADVISORY 11' G??d Hygienic Practices 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22); of Health. Non-critical (N) violations must be corrected . . . . Official Order for Correction: Based on an inspection Immediately or Within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR 590.000lFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23' Management and Personnel order of the Board of Health. Failure to correct violations 24' and Hum Protection cited in this report may result in suspension or revocation of 25? Equipment and UtenSIls the food establishment permit and cessation of food 25? Water, Plumbing and Waste establishment operations. If aggrieved by this order, you 27- Physical Facility have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF IRE-INSPECTION: z" Inspector's {Cam Print: {Iii-1 aft/"I Keg/3(? f/ ?i I?iC?s Signature: g, Mfr-V, (/44 Print: {#7941 S. Page?IWA?l?ugcs FORM 734A AM SULKIN CO CHARLESTOWN MA Violations Related to Foodhome illness Interventions and Risk Factors (Red items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Cross-contamina lion IT Assignment of Responsibility? 590.003t?) Demonsnation of Knowledge? 2103.1 1 Person in charge - duties EHPLOYEE HEALTH 2 Responsibility of the person in charge to require reporting by food employees and applicants? Responsibility Of A Food Emplyee Or An Applicant To Report To The Person In Charge? Reporting_by Person in Charge? I 3 Exclusions and Restrictions? Removal of Exclusions and Restrictions Raw Animal Foods Separated from Cooked and RTE Foods? Contamination from Raw ingredients 3-302.1 Raw Animal Foods Separated from Each Other? Contamination from the Environment Food Protection? 3602.15 Washingiruits and Vegetables* 3-304.11 Food Contact with Equipment and Utensils? Contamination hum the Consumer unaware} Returned Food and Reservice of Food? Disposition ofAdulterated or Contaminated Food 3-701.ll Discarding or Reconditioning Unsafe Food* FOOD APPROVED SOURCE I 4 Food and Water From Regulated Sources 1 9 Food Contact Surfaces Compliance with Food Law? 3-201 . 12 Food in a Hermetically Sealed Container? 3-201.l3 Fluid Milk and Milk Products? 3-202. 13 Shell Eggs? 3-202.14 Eggs and Milk Products. Pasteurized? 3-202. 16 Ice Made From Potable Drinking Water? 5-101.1 1 Drinking Water from an Approved System? Bottled Drinking Water? Water Meets Standards in 310 CMR 22.0? Shell?sh and Fish from an Approved Source 3201.14 Fish and Recreationally Caught Molluscan Shell?sh? 3-201.15 Molluscan Shell?sh from NSSP Listed 4-501.111 Manual Warewashing - Hot Water Sanitization Temperatures? 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures" 4-501.l 14 Chemical Sanitization - temp. pH. concentration and hardness? 4-6011 Equipment Food Contact Surfaces and Utensils Clean? 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils"r 4-702.? Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment? 45703.11 Methods of Sanitization - Hot Water and Chemical? Sources? I 10 Game and Wild MushroomsApproved by RegulatoryAuthorlty 3-202.18 Shellstock Identi?cation Present? Wild Mushrooms? 2-301.ll Proper, Adequate Clean Condition - Hands and Arms? 2-301.12 Cleaning Procedure? 2-301.14 When to Wash? 3.201.17 Game Animals? I 11 Good Hygienic Practices 3-202.11 PI-IFs Received at Proper Temperatures? 3-202.15 Package Integrity? 2401.11 Eating. Drinking or Using Tobacco? 2401.12 Discharges from the Eyes, Nose and Mouth? 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated?"r I 6 Tagisecords: Shellstock 12 Prevention of Contamination from Hands 3-202. 18 Shellstock Identi?cation? Preventing Contamination from Employees? 3-203. 12 Shellstock Identi?cation Maintained? [13 Handwash Facilities T_ag?l?ecords: Fish Products 3402.11 Parasite Destruction? 3402.12 Records, Creation and Retention? 590.0040) Labeling of Ingredients? 7 Conformanca with Approved Procedures Plans 3-502.l 1 Specialized Processing Methods? 3602.12 Reduced oxygen packaging. criteria? 8-103.12 Conformance with Approved Procedures? Denotes critical item in the Federal 1999 Food Code or 105 590.000. Conveniently Located and Accessible 5-203.11 5-204.11 Numbers and Capacities? Location and Placement? 5-205.1 1 Accessmility. Operation and Maintainance Supplied with Soap and Hand During Devices 6-301.11 Handwashing Cleanser, Availability $301.12 Hand Drying Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN OR CITY OF P) ?4 mom 0K Establishment Name: :9 1 59mm 4:5 gamble?; Emma: bag/- 9 Page: of Item Code c-cnucamsm Data No. Reference R-Red Item Em? my Veri?ed r? 9690 WM 121% basalt. (m UOL - 140/539 choc/oz. QMQM (Ad?a4 900$ elm/I Malay Ww?f/ Dob 60-4 00M 'Discussion With Person in Charge: Corrective Action Required: El No Yes El Voluntary Compliance Cl Re-inspection Scheduled El Embargo 0 Voluntary Disposal El Employee Restriction I Exclusion 0 Emergency Suspension [3 Emergency Closure Other. Form 734 8 AM. Sulkln 60.. Boston. MA Violations Related to Foodbome Illness Interventions and Risk Factors (Red'ltems 1-22) (Cont) PROTECTION FROM CHEMICALS 14 Food or Color Additives 3.202.12 Ach-itives" 3-302.? Protection from Unapproved Additives" 15 Poleonous or We Substances 7-101.l 1 Identifying lnfonnation Original Containers" 7-l 02.1 I Common Name Working Containers" 7-20l .l Separation - Storage" 7-202.l 1 Restriction - Presence and Use" 7-202.12 Conditions of Use" 7-203. 11 Toxic Containers - Prohibitions? 7-204. 1 Sanitizers, Criteria Chemicals" 7-204.12 Chemicals for Washing Produce, Criteria" 1-204.? Drying Agents, Criteria" 3-501 . PHFs Received pt?Ten-iperatures According to Law Cooled to Within 4 Hours. 3-501.15 Cooling Methods for I9 PHF Hot and Cold 3-501 . 16(3) 590.0040) Cold PHFs Maintained at or below 41?l45? Hot PHFs Maintained at or above Roasts Held at or above [20 Time as a Publlc Health Control 3-501.19 Time as a Public Health Control" 59000401) Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 21 3-80l.l Unpasteurized Pie-packaged Juices and Beverages with Warning Labels" 7-205.? Incidental Food Contact. Lubricants" 7-206.? Restricted Use Pesticides, Criteria" 7-206. 12 7-206. I 3 Rodent Bait Stations" Tracking Powders, Pest Control and Monitoring" Use of Pasteurized Eggs" 3-801 .i Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. Unopened Food Package Not Re-served. CONSUMER ADVISORY CONTROLS 16 Proper Cooklng Temperatures for Pl-lFs 22 35-603.] 1 Eggs- 15 Sec. i Eggs- Immediate Service 145?F155ec" Pathogens." 2mm manor Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or Not Otherwise Processed to Eliminate 3-302.? Pasteurized Eggs Substitute for Raw Shell Eggs" 3401.11tAx2) Comminuted Fish, Meals at Game Animals - 155?]? 15 sec. 3-40? Pork and BeefRoast - 130?? 121 min" 3401.1 Ratites, Injected Meals 15 see. It Poultry, Wild Game, Stuffed PHFs. Stuf?ng Containing Fish, Meal. Poultry or Ratites-165?F 15 sec. Whole-muscle, Intact Beef Steaks 3401.12 Raw Animal Foods Cooked in a Microwave 3-401-1 All Other MW 15 sec. l7 REheatIng for Hot 3403-] PHFs 15 sec. 3403.1 Microwave- 165? 2 Minute Standing Time" Commercially Processed RTE Food - Remaining Unsliced Portions of Beef Roasts" I 18 Proper Coollng of PHFs 3-501 - Cooling Cooked PHFs from l40?F to Within 2 Hours and From to Within 4 Hours. - Cooling PHFs Made From Ambient Temperature Ingredients to Within 4 Hours" Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. SPECIAL REQUIREMENTS Violations of Section in catering. mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLA RELATED TO GOOD (Blue Items 23-30) Critical and non-critical violations, which do not relate to the foodborne illness interventions and risk jbctorr listed above, can be found in the following sections of the Food Code and 105 CMR 590.000. 23. 25. 28. Food and Water Practices and Town of Plymouth Public Health Department Food Establishment Inspection Form 26 Court St. Plymouth, MA 02360 Tel: 508-7474 620, Extension 10118 Hams listleilhrt?rsrr emit? Address 1 "j 1? Telephone gt?; flat: {495:0 =Iisk Cat'egory: El Low El Med High Town Of *Iqmocobk HACCP: CI Yes No Person-ln-Ch?rgo {Picl L) Sd Time In: Time Out: 35%! Operation (5) Food Service El Retail El Residential Kitchen l:l Mobile Temporary Caterer Bed 8. Breakfast Permit Number: Tmypa' of Inspection Routine Cl Re-inspection Previous Inspection Date: Pro-operation El Suspect illness General Complaint El HACCP Other Fan Karim FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (W, OUT, NIO. NM) {or each numbered item IN compliance. OUT =_n_o_t_l_r1comp iance. NIO not observed. NIA not applicable SUPERVISION Ca piianca Status i" [3 OUT 1. PIC present. demonstrates knowledge and performs duties IN Cl OUT MIA 2. Certi?ed Food Protection Manager present Mark in appropriate box for COS andior COS El 3E1: EMPLOYEE HEALTH Compliance Status MN OUT 3. Management. food employee and conditional employee. knowledge. responsibilities and reporting 4. Proper use of restriction and exclusion of exposed, sick. employees 5. Procedures In place for responding to vomiting and diarrhsal events Eta: El COS corrected on-sile during the inspection. repeat violation TIMEITEMPERATURE CONTROL FOR SAFETY 18. Proper cooking time a temperatures Proper reheating procedures for hot holding 20. Proper cooling [late and to mp craters 21. Proper hot holding temperature 22. Proper cold holding temperature 23. Proper date marking and disposition 24. Time as a Public Health Control mplionco Status OUT our NM mo LliHID CONSUMER ADUISORIES Co pliance Status 1' OUT NIA 25. Consumer advisory provided for I'ood COS GOOD HYGIENIC PRACTICES Co pliance Status itvt OUT N10 6. Proper eating. lasting. drinking. or tobacco use 7. No discharge from eyes. nose. mouth. or open woundsl'soras ?irt] OUT NIO REQUIREMENTS FOR HIGHLY SUSCEPTIELE POPULATIONS (HSP) Co plianco Status OUT MA 26. Pasteurlzad foods used: prohibited toods not o?ered C05 [3 PREVENTING CONTAMINATION BY HANDS pilencs Status NIO arm?cr our ti. Hands clean and property washed 9. No bare hand contact with RTE load 10. Adequate sinks properly supplied and FOODICOLOR ADDITIVES AND TOXIC SUBSTANCES Compliance Statu Food additives: approved 8. property used NM. 28. Tonic Substances properly Identi?ed. stored 8- used FOOD PROTECTED FROM CONTAMINATION Cp?lplianco Status tint] OUTD CI our NIA our 11. Food separated and protected 12. Food-contact surfaces: cleaned and sanitized 13. Proper disposition of returned. previously served. reconditioned and unsafe Iood l3 - APPROVED SOURCE Sy?plls?ani "it? us -, IN OUT .5ng- Food obtained from approved source Li.? OUT NIA 3 MO 15. Food received at proper temperature OUT 16. Food received In good condition. safe. and unadulterated OUT NIA NIO 17. Required records available: shelistock taps. parasite destruction Cl CID [Ira cos El CONFORMANCE WITH APPROVED PROCEDURES Co Status [1 OUT NIA 29. Compliance with variance I specialized precoss Plan COS [In foodborne illness and/or injury. Foodborne illness risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness and/or injury. Public health interventions are control measures used to prevent such GOOD RETAIL PRACTICES Good Retail Practices are preventive measures to control the addition of pathogens. chemicals. and phytucal objects into foods and the food system. Mail: ?1 in lhe boat ii numbered item is not In compliance Mari: in the appropriate box tor COS andior COS corrected err-site during inspect-on a retreat vrolalion SAFE FOOD AND WATER I J49. Pastaurized eggs used where required 1?6 31. Water a- Ics from approved source 32. Variance obtained lor specialized processing methods a COS Cl Compliant Slim-IE FOOD TEMPERATURE CONTROL 33. Proper cooling methods used: adequate equipment (or temperature control 34. Plant teed properly cooked for hot holding KER. 35. Approved thawing methods used .1 35. Thermometers provided 8 accurate Compliance Status PROPER USE OF UTENSILS 43. ln-use utensils property stored 44. Utensils. equipment 8- llnons: properly stored. dried. 8. handled 45. Single~use I single-service articles: properly stored 8- used 46. Gloves used properly COS UTENSILS. EQUIPMENT. 8- VENDING 47. Food 8. non-food contact surfaces cleanebls. properly designed, constructed it. used 46. Installed. maintained. a used: test strips 49. Non-load contact surtncaa clean Complla on Status 3 RR COS CID E1132: Complianc Status FOOD Food properly labeled in original container PREVENTION OF FOOD CONTAMINATION 38. Insects. rodents, s. animals not present 39. Contamination prevented during tood preparation. storage 8. display 40. Personal cleanliness Commit? Status 41. Wiping cloths: properly used 8. stored 42. Washing fruits 8 vegetables PHYSICAL FACILITIES Sit. Hot 8. said water availahls: adequate pressure 51. Plumbing Installed: proper backllow devices If 52. Sewage 5 waste water properly disposed 53. Toilet features: properly constructed. supplied. is. .. 1 Cleaned I -. 5d. Garbage t9. refuse properly disposed; facilities tug-ff (Ln-??nanuatned tiff; 55. Physical facilities in static it. maintained. d- cisanatt i] 56, Muquato ventilation a. lighting: dosig natod areas r?i'Tu . greed J- Comp"? Status l2! {if} or: Domingo DECIDED SPECIAL "Check box when iound to be In compliance" is local BOH Regulation ti Allergen Awareness (5'30 Anti-Choking I500 Tobacco Li OFFICIAL ORDER FOR CORRECTION: Based on an inspection today. the items checked indicate violations of the Plymouth Board of Health Food Regulation! 2013 Federal Food and Drug Administration (FDA) Food Code, This In port. 'Ihhl'l't shined by in Plymouth Public Health Duparlt?nenl Inspector or an agent constitutes an order oi the Board of Health. Failure to correct violations cited in this report may result in suspension erruvmzation either lowed estatdivhmont partial and cessation oi food establishment operations It mature-v64 by this order. you have a right In a hearing with the Board oi Health. Your request for a Board at Health hearing In writing to the Public Health DuptirtIn-i: Liar": Diana" Signature: at "In :tnovu .nitrrus da 5 streamer at the enter 451/1} Flo's Email: Date Signed: Inspector?s. ?end?turn: /a A If} Follow-Up Ragutrart: YES if kg NO It Iollow?up is required. Indicate followup oats: - Revrsed 11/2017 Pane 1 of 6 Town of Plymouth Public Health Department 26 Court St. Plymouth, MA 02360 Food Establishment Inspection Form ObservationIActlon Sheet Tel: 508-747-1620, Extension 10118 TEMPERATURE OBSERVATIONS Item/Location Tem Item/Location Tern ItemILocation Tem 5 must be corrected rames or as Federal Food Code Section (mg i .. Court mh?g?i Above Items discussed with PIC: Yes NO If why l'lOiI .. . .- .. - - - - - - - A - -- - Additional PIC discussion details: Correclive Action Required: Yes No El Voluntary Compliance El Employee Restriction I Exclusion El Rea-inspection Scheduled Emergency Suspension Embargo El Emergency Closure [1 Voluntary Disposal Other Revised 1112017 Penn 3 of 6 24131.11 and 2- 1 24112.11 2403.1 .1 2-201.11 2-101.12 2?201 .13 1.11 3301.12 2-301.16 1 1 Protection Holderthe Permit Holder. PIC. and Conditional Employees - of the 1 Restrictions Adjustment. or Retention of Exclusions and Restrictions of Vomlti and Events Numbers Using a Handfuashing Sink Operation and i destruction PROTECTION FROM CONTAMINATION 3-3911 11 and Unpacksged Food Separation, a. [P.cl .111 and Use limitation Equipment. HoiWaier .11 .114 and Mechanism Equipment. Chemical Sanitizalion - Temperature. pH. Concentration and Hardness 4-6?1. pmenl, Surfaces. Non-food Con Utensils Proper disposition of served, rem roosdures for hot ho Consumer 1 Consumption of Animal Feeds are . or Not Otherwise Processed to Eliminate ns iblted too s-eo1.1 1m). (31- iE). Prohibited Fund and - Containers 02.1 1 1 3602.12 5103.12 8-103.? 30- AND WATER re Pasteurized Eggs Substituted-fonRew Eggs tor - Certain Ice Standards - Water Documentation of Proposed Variance and in use: adequate equipment for Methods $301.11 Heating. (P0 $203.11 emperature Measuring rm 204.112 Temperature Measuring Devices (H. c) 1 Food Temgereture 1 container Shuoked 8- identi?cation Food Storage Containers identi?ed with Common Name of Food at animals not 5202.13 6 6501.111 Pests .112 Removing or rapped Pests Contamination prevented during food storage. 19 Condition 11 as Exterior Coolant. Prohibited as (Pi or of Food In Contact with Food Storage Preventing Contamination from Prohibited Areas Food Display - (PD Contamination Distressed items $304.14 4-1 $901. 2 3-3011 5 7. 4-9021 1 116 $204.11? 4-301.12 13 Iii-501.115 Condition -- Duter Cloth] for log. Treatment. Storage and Pm?ssing Fruits and Vegetables. dried 8- handled iteme (except 4-901.12. 4-903. and $904.1 Single-Serums and Single-Use Use Using Clean Tableware for and Refliis for Construction and 13. 4- 203. 41-20411. 4-204.110IBL 4404.112 4. Equipment. as . Dryers and Storage Cabinets. Contamination Prevention Spacing or Sealing Good Repair and Proper Ovens - Utensils end ntect rna M658 Machine, Date Piate Dpe emperature rm Manual (Po Sink Compartment ui (Pic) Temperature nee. Mechanical .12 to Equipment Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM NAME: PCIS Address: 172 Long Pond Road Phone: 508-830-4474 Last lnsp. Date: 12/12/17 Purpose of Inspection: Routine Type of Establishment: Food Establishment (School) Risk Category: High Time In: 1t:l:lo Signature: ?me DATEWNIB Inspection by: Marcia Lee PIC Received by: Brenda Crowdis Signature: Managers Email:bcrowdis@plymouth k12.ma.us Permit Holder: Plymouth School System Foodborne illness risk factors are Import.) nt practices or procedures identified as the most prevalent contributing factors of foodborne ness and/or injury. Public health interventions are control measures used to prevent such foodborne illness andfor in]ury. Types of Inspection: Routine, Re-lnspection, HACCP, Pre-Operation, Suspect Illness, Complaint, or Other Reinspection Date: ernse?'enntt HumbehFood Establishment "#55 .Mllk 3'9? Corporate Email; i rne.us 2/7/2019 ITEM Points IN OUT N10 MIA cos COMMENTS Approved source for food, water, and ice; wholesome. nonadulterated 3 I I I I NI 'Io-odr. must be stored in air tight, covered, labeled recepticles designed tor tho intended use Foods must be labeled to identify ITEM Paints IN our cos COMMENTS Potentlally hazardous food meets temperature reqUIrements during storage, preparation, cooking, cooling, holding, display, sawed and trans nation 3 Adequate lac as to maintain product temperature, thermometers provided 3 Themiometers provided and accurate, properly calibrated. 1 Potentially hazardous food property thawed 2 Unwrapped or potentially hazardous food not reserved 2 Food protected dunng storage, preparation, display, service transportation Food containers stored Off?oor Washing fruits and vecetables 2 2 Plymouth Produce is supplier say all prewashed. No veg/fruit wash On Order Handling of food and ice minimized No bare hand contact with ready-to-eal foods, proper utensils used, or approved alternale method rooert followed 3 In use food dispensing utensils properly stored 1 3: ITEM Phansraphs EMPLOYEE HEALTH Points IN OUT cos COMMENTS Management awareness; written health policy present Proper use Of reporting, proper restriction exclusion for reportable diseases NO discha from eves nose or mouth observed 3 12 Proper eating, tasting, drinking Good hygienic practices, proper handwashing and glove changing observed, smoking restricted 3 I Has reportable food posted Proper hair and heard restraints are worn correctly, clean uniforms, kitchen whites, and aprons. 1 1 8. UTENSILS: 3. INSTALLATION Points IN DUT MIA COS COMMENTS 14 Food-contact surfaces designed, constructed, maintained, installed, located 2 Badly scorred stained cutting boards need replacement or resurfacing. On order Nontood-contact surfaces designed, constructed, maintained, installed, located 1 1 Still need some proper dunnage racks in the walk in 15 Dishwashing facilities approved design, adequately constructed, maintained, installed, located 2 1! Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present Temperature and psi gauges are . accurate 1 Tablewares and Equipment is pro??ushed, scraped, and soaked prior to cleaning 1 19 Wash and rinse water is clean, and at proper temperature 2 Ii Sanitization rinse (hot water- chemical) Proper sanitization of food contact surfaces through temperature, chemical concentration exposure time for and utensils 3 Phi-rump!? PROTECTION FROM CONTAMINATION Point: IN OUT NIO NIA COS COMMENTS Wiping cloths properly stored clean and dry or in a sanit ing solution 3 Fond-00mm Surfaces 0f Mimi's 5 eqUiPmem clean 2 I: Did equipment has accumulated soils. must be cleaned or removed Nonroo-u-oonlaia surface-s oi utensil: nquiprnovnt clean. 1 Proper equipmentlutensils storage, handling, to prevent contamination 2 Single service articles are from an approved source, are stored, handled, dispensed, used and disposed ofin a mannerthat revents contamination 1 No re-use of single service containers for food or chemical storage 1 I: Photolriptu WATER SUPPLY 5 DISPOSAL Points IN OUT NED NM. C05 Water supply is from an approved source and water supply is suf?cient forthe operations intended 3 COMMENTS Sewage disposal approve: Proper-disposal otmmtu Willa: I'ngmvod [In atop punks] '5 3 ITEM I emulate IFLUIIBING Court St. Plymouth, MA 02360 Tel: 508-747?1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Location, installation, maintenance (ie dripping faucets, routing pipes, Impropony wasting Film}. 2 I: COMMENTS Plumbing installed preventing cross connection, back siphcnage. back?ow 3 Adequate handwashing facilities. easily accessible, designed, installed 3 32 Toilet facilities: property constructed, selfclosrng doors, ?xtures In good repair, supplied soap and towels In dispensers! hand-drying devices, cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from Food recess-in and stor areas 2 Pitch-Israelis FACILITY AND GROUNDS Points IN OUT NIO NIA COS Su?iceint covered trash recepticles present in adequate number, leak proof, insectlrodent proof. emptied adequate frequency_ clean 2 Outside premises are free from trash, etc . free of harborages, breeding places for rodents, insects. and other pests Outside areas (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled incineration 2 Doors, windows, and other openings are protected to eliminate entry by insects, rodentsi'pests No evidence of pests present Doc rs to exterior are not Elosmg, there IS a gap at the bottom and middle With 3 3 approx 3/4? gap Premises does have an issue with mice entry Plum-raphs FLOORS, WALLS ii. CEILINGS Points IN OUT NED NM cos COM-M ENTS Proper floor construction, proper ?oor covering installed, ?oors graded with drained as required, ?oor and wall juncture covered Floors in cod air and clean Dustiess cleaning methods used as needed 1 Walls, ceilings, attached equipment, property constructed, good repair, clean Wall ceiling surfaces as required Dustless . . . . . 37 damng ?mods ?and an 1 Dust attached to the calling tiles In need of cleaning Adequate lighting provided for sul?cient candle light Fixtures properly shielded or use of shatter prood bulbs 1 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, other airborne substances 1 Locker rooms. employee changing areas. provided, located to prevent contamination Of production areas, and used for storage at employee personal items properly equipped and property ventilated Dressing rooms are maintained in good physical repair, 1 Insecticides and rodenticides are used and stored so as to prevent contamination of loco items Detergents, sanitizers and other cleaning supplies are used in a safe, elfective manner Hazardous materials are kept in their original containers and stored separate from raw materials 3 Premises maintained free of litter. unnecesery items and articles, cleaning maintenance equipment properly stored, Remove all unecesary eqpuipment or clean and repair. Example the old proof box, 1 1 mixers. dough machine. Seperation of maintenance rooms and equipment, laundry facilities by partition 1 Edited linens property stored 1 mm Phutncraphs RESPONSIBLE PERSON IN CHARGE Points IN OUT NIO NIA COS COMMENTS Certi?ed Food Protection Manager 3 45 PIC is knowledgeable and understands sanitary controls demonstrates competence 2 ITEM HIGHLY SUSCEPTABLE POPU LATIONs PoinoFission-zoo usoo. memories toads not attainITEM ammo FOODICOLOR ADDITIVES IPointsl our NIO MIA cos 43 Food additives:approved and properly used EQUIPMENT AND UTENSILS Point. IN OUT MO MIA cos COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food 2 1t Instruments and controls used tor measuring, regulating, or recording temperature, pH, acidity, water activity, or other conditions are accurate and ads uatel maintained 1 innovators, and other Wm'br are accurate and maintained 1 ITEM rum-ram LICENSURE Points iN OUT Nr'o NIA. cos COMMENTS 52 Firm is curremiy licensed by the regulatory authority havmg jurisdiction 1 Phatnlriphs CONFORMANCE WITH APPROVED PROCEDURES (WT 1 pt for all) Points Anti-Choking 1 Scheduled in February with CPR Smoldn 1 I 0 Local BOH Regulation 1 26 Court St. Plymouth, MA 02350 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM QMum for responding to vomiting 5: dimhcaJ proc ass of writing ITEM Photographs RECORDS IPointsI our are i an. I cos COMMENTS 54 Required records available: shellstock tags, parasite destructionIime As a Public Health Control. required logs ITEM Minn? RECORD CHECKLIST Water quality and supply records, grease trap cleaning record, ansul system cleaning records and tags current, Fire on: uisnert 1 Greasetrap done one in December. No ansul/hood Employee training records I Tan-upmaturn control records it Equipment monitoring and maintenance records it Calibration records at Sanitation records it Required Logs: Time as a Public Health Control, Receiving Temperature. parasite destruction :1 Pest control records it Eco labs Variance request and approval. Time as a Public Health Control Procedure Inspection records (a . incoming product facility. production area) 1: ITEMS OBSERVED IN: In Compliance Critical Items Observed (Primary. Primary Foundation) 1 OUT: Out of Compliance Non-Critical Items Observed (Primary Foundation. Com) 4 NIL): Not Observed Total Non-Compliant Observations 5 Not Applicable COS: Corrected on Sight Score: 92 R: Repeat Violation amen ono?t FDR corms-coon: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation I 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten {10) calendar days of receipt of this order Additional Notes: It was a half day and no food was being served when I previously went to inspect. I was able to look at the physical premises and used that information during today's trip Iwent over my findings with the Manager and Director Add ional time from my first visit was approx 30 minutes and is not included in the time in and out from todays visit. Some of the work is been ta ken care of Some work is outstanding and the manager will submit A work order For that work . The ansul system 5 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Dlag'an's: has not been Ta ken care of However that is beyond the control of the manager As well as the removal of Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM NAME: PCIS Time In: 9:15 Tit-no oum mi- perineum-n Address: 172 Lon Pond Road Inspection by: Marcia Lee identi?ed 35 the "105? prevalent contributing lactors of foodborne . . . Phone: 503.330.4474 Siam-lure ?ak Illness and/or iniunr. Public health interventions are control measures Last Insp. Date: 12/12/17 PIC Received MI: Brenda Crowdis used to prevent such foodbarne illness and/or injury. Purpose oi Inspection: Routine Signature: I51. nit?? Type of Establishment: Food Establishment (School) Managers ma us Suspect Illness, Complaint, or Other Risk Category: High Permit Holder: Plymouth School System Reinspection Date: License-{Permit Rumba-mood Establishment?196 .h?rillt 797 Corporate Email: kilmaus 2/7/2019 ITEM rim-pin souacs or room PointsI IN I out NIO Hill cos a cm I: 1 Approved source [or food. watemnd ice; wholesome, nonadulleraled FOOD PROTEC TIDN Points IN OUT NIO COS Polenl hazardous food meets temperature requirements during storage preparation, cooking, cooling, holding, display, service and transportation 3 Adequala fatalities Io maintain product temperature. thermometers provided 3 Thenrlomelers provided and accurate. properly calibrated 1 Potentially hazardous food property thawed 2 Uftwl?apped or potentially hazardous load It not reserved 2 7: Food rolected during storage, preparallun, display, semee Ii transponalron Food containers stored olf floor Washing hurts and . magni?es 2 2 Plymouth Produce Is supplter say all prewashed. No veg/fruit wash Hand] ng of load and ice No bare hand conlact readyto-eal foods proper utensus used, or approved alternate nut-tr ores-Mu 3 I In use food dispensing utensils properly stored 1 Jr EMPLOYEE HEALTH Points IN our 0 run co a Management awareness wntlen health policy present Proper use 0! reponing, proper restriction a exclusion for reportable diseases No discharoe lrom eves nose or mouth observed 3 - Proper eating, lasting, drinking Good hygienic practices proper handwashmg and glove changing observed, smoking 3 Has reportable fond posted Proper hair and heard restraints are worn correctly. clean uniforms, kitchen whites, and aprons. "will? 8 UTENSILS: DESIGNLONSTRUCTIOH 3. INSTALLATION Polnts IN OUT NIO NIA COS COMMENTS 14 Food?contact surfaces designed. constructed, maintained, installed. located Improper storage (bread trays, milk crates) used in cold units, they do not allow easy cleaning methods and do not raise food 6? off the ground. The units used are not designed for the intended use of food storage. Badly scarred stained cutting boards 2 2 need replacement or resurfacing. Nonlood-contact surfaces designed, consu-ucled, maintained, installed, located 1 2 Need proper storage units in dry storage. bread trays are not approved for use Dishwashing facilities approved design, adequately constructed, maintained Installed, located 2 Proper chemical lest kits, measuring devices for on. thermal slaps. and logs are present. Temperature and gauges are rate 1 Logs Ior sanitizer Tablawares and Equipment Is pro-flushed, scraped, and soaked prior lo cleaning 1 Wash and rinse water is clean. and at proper IemDefalI-Ife Sanitlzalrcn nnse (hot water - chemical) Proper oI Iood contact suriaces Ihrough temperature, chemical concentration Took 5 runs to hit 160F at the plate. Plumber is going to raise the hot water to exposure time for equipment and utensils 3 dishwasher today Merl-pl? PROTECTION FROM CONTAMINATION Polnts IN OUT MIA COS COMMENTS Wiping cloths properly stored clean and dry or In a sanitizing solution 3 Numerous wiping cloths were on counters soiled Corrected inspection. mead ?rm? "was?: 8' mummy? ma" 2 I at Old enuipment has accumulated soils. must be cleaned or removed. Nonlood-contacl surfaces or utensils II. equrpmonl clean 1 Proper equipmon?tl'utensils storage, handling, to prevent contamination 25 Single service articles are from an approved source, are stored. handled dispensed, used and disPOsed of in a manner that prove I: 1 . No re?use or service containers Ior loan or chemical storage 1 1 Ruse of numerous it'hnt't' containers in the kitchen Must use proper container' PMmc?nln WATER SUPPLY a DISPOSAL IPolntsI IN I OUT MO I will. I (05 a 27 Water supply is Irom an appro?red source and water supply :5 sullrcient for the operations. intended I 3 I I I I COMMENTS 26 Court St Plymouth, MA 02360 Tel: 50851411620, Extension 10118 .. Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM disposal approved. Proper disposal oi waste water in approved disposatleeilities (to stop sinksPLUMBING wr IN OUT H10 WA cos Location. mun-mm, numtenance (in denim faucets. loathe pipes. manna Pipes). 2 1 COMMENTS Plumbing inste?e-d pnvenb'ngereu connect-om . tied-c Homage. becktlew. 3 I Adequate tunewashing facilities. easily accessible. designed. Installed 3 Toast facilities property constructed sell dosmg doors Mae; in good repair supplied with soap and Innis e1 dispensersiI tund- drying devices deaned reception? nerduult sign-gamete Toiletleeiitiesheve led-doshgdeers ?Mademtopenm mummies-d and roman-amorous main-lg and storage areas. 2 mere mom" mo GROUNDS PointSuf?eeint covered trash receptleles present in alert-late number. leak proel, insectirodenl prool. emptied with adequate frequency. elem 2 it 34 areas (reeds. yards. disposal system] provide adequate drainage and do not constitute a source eteontemination. Controlled Inciteratiort. 2 it Doors. windows, and other openings are protected to eliminate entry by Insects. No evidence of pests present Doors to exterior are not tight closing. there is a gap at the bottom and middle with 3 3 approx. 314' gap. Premises does have an issue with mice entry. FLOORS, WALLS e. CEIUNGS Polnts IN OUT N10 NIA COS COMMENTS Proper ?oor proper l'leer hastened. ?oors graded with drained as raqulred. ?oor and wall Iunelure covered. Floors in re and clean. Dusttese eleeni methods used as needed. 1 I. Wait . hacieedequrpme' ill. slrucled. . elem Walle- eeii' statutes as uired Oustiess 1 mung, WI WV :l Dust attached to the ceiling tile: In need ofcleaning Adequate lighting provided lor sull'n'ent candle light. Fixtures property shielded or use of shelter proud bulbs. 1 I Air quality and ventilation are adequate to remove excessive heat tor equipment and rooms and prevent eentaminauon by dust. mdler other Illbornn substances 1 I Locker rooms. employee changing areas. prwided. located to prevent contamination of production areas. and used for storage oi 1 41 Insecticides and rodenticides are used and stored so as to prevent contamination et tood items Detergents. saruuzers and other cleaning supplies are used in a sale. e?ective manner. Hazardous materials are kept in thu'r original containers and stored separate from raw materials. 3 42 Premises maintained tree of litter. mnecesery Items and attain. alumina maintenance new at meow stored. Remove all unecesary eqpuipment or clean and repair. Example the old proof box. 1 1 mixers, dough machine. 1 Sorted Imam properly tiered 1 .11 nun-m RESPONSIBLE reason in camera Peta-m IN OUT mo MIA cos mMMEms 45 Codi?ed Food Protection Manager 3 46 PIC is knowledgeable and understands sanitary controls demonstrate competence 2 ITEM HIGHLY POPUIATIONS Points IN OUT HID NIP. C05 41 Pastuertsed foods used; prohibited loads not altered. 3 HEM Fm? Points our Fill] "In cos 43 Food and properly used 3 Points IN OUT NIO NIA COS COMMENTS Ailments Meow-renewal and products 2 unmet-terns meanwhusedler mama-lg, WW. unending waterml?vitymremeseendaiem -matiam. 1 it 1'1" - equtplnent 7 -le'ID?'I?l?fl HEIGHT. ?cesarean!? BIB OI aequae 1 it ucensune mine In our mo cos commons 51 1 I ITEM I Wain APPROVED 1 pt let all] link-Isl Court St. Plymouth. MA 02360 Tel: 503-747-1620. Extension 10118 RETAIL FOOD INSPECTION FORM Town of Plymouth Public Health Department 1 1 I Hoods thorn mrli?-ealo 1 1m mum 1 1 Scheduled In Februa with CPR 1 1 I Procedures for responding to waiting diarrhea! events 1 '5 pro: ?55 COMMENTS mam Hui-wt- [means so Required records ?ethical-re ruled: up, mmiro d1 ?rumor-1.11m As a Public Hell-1h Control. required Ines IPolntsI?IN Jourl NIOI MIA cos ll_it_ inseam CHECKLIST Watorqualily and simply records. grease trap cleaning record. Insul system cleaning records and tags current. Flre uishor Ions ermn: Greasetrap done one in December. No ansullhood Terr-room? mural records Eqrr'pmem murmur-ma and mar-rm row-rd! Celibrationreoords Sanitation records Pest oonIrol records Eco labs Variance request Elli! approval. Time as a Public Health Control We Inspection records to a . incoming product. facility. production area) ITEMS OBSERVED Critical Items Observed (Fri-rm. pm rue-um) Non-Critical Items Observed (Frill-w rum-mean] Total Non-Compliant Observations Score: 88 IN: In Compliance OUT: Out of Compliance N10: Not Observed NIA: Not Applicable Corrected on Sight li= Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the Items checked Indicate violations of the Plymouth Board of Health Food Regulation I 2013 Federal Food and Drug Administration (FDA) Food Code. This report. when signed belowor dellvered using electronic mail. by a Plymouth Public Health Department Inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited In this report may result In suspension or revocation of the food establishment permit and cessation of food establishment operations. It aggrieved by this order,you have a right to a hearing with the Board of Health. Your requat for a Board of Health hearing must be In writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: 26 Court St. MA 02360 Tel: 508-747-1520, Extension 10118 Diagrams. T- . .. 13- Isl-j 7 got; . i: Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Plymouth North High School Address: ?1 Obery St. Plymouth. MA 02360 Phone: 508-830-4400 Last Insp. Date: Purpose of Inspection: Routine Type of Establishment: Retail Food. Milk, Food Production Risk Category: High Tlmo In 11:30 Time a. 2:01? panama?; Inspection lav: Mimi: Lee Slgnature: PIC Received Slgnaturejl Mung! E: a: Managers Emarla'tisa. stoned? p'vrnri'ul 2 ma us Permit Holder. Plymouth School Department identified as the most prevalent contributing factors of foodborne illness and/or injury. Public health interventions are control measures used to prevent such foodbome illness andlor injury. Suspect Illness, Complaint, or Other Reinspection Date: Utense?'erml: Number; milk 2166, Retail 2160. Food 814 Corporate Email: ovancciu? :ilvmauzh.k12.ma_us ITEM SOUHEE OF F000 IPolntsI IN IDUT INIO ill/A I COS COMMENTS 1 mm mm: lor loo-d. ice. wholesome, nonadr?lcraled I 3! I I I Wm: Fool: PROTECHON Points IN OUT Nlo MIA cos comma?: Potentially hazardous food meals lemperalure requiremonls during slorage. preparalion. cooking. holding. display. sen-rice and Iran nation 3 Ada-cualo facilities to malniain product temperature, ?reman-later: provided 3 Tnamomerers promed and accurate, property calibrated 1 It Potentially hazardous lood properly Ihaweo. 2 Wrapped or polontialtv hazardous loan not resolved 2 Food protected dunno storage. preparation display, service 8. transportation. Food containers stored ofl ?oor Washing fruits and stables 2 it Do not use a chemical vegetable rinse tor frurts and vegetables Handling of Inc-d and minimize-o bani.- moo contact with readrlo?eat proper urensds used. or approved mic-mm: rrlelI-iod wooed lollmd 3 In use ?ood dispel-ism; u'lct'?JL?l properly sic-red 1 it We!? EMPLOYEE HEALTH Pornrs IN OUT N10 MIA C05 Fl CUMMENIS Management awareness: wnllen health policy present Proper use 01 reporting, proper restriction 5 ext-Jus'ron lor reportable diseases No discharge from eves nose or mouth observed 3 12 Prime! eating, lasting. crma; Good prance-ii proper ram: washing and glove changing moi: rig surlr en . 3 it Is going to set up a hydration station, numerous beverages were on prep surfaces Proper hair and heard restraints are worn correctly. Clean uniforms, kitchen whites, and aprons 1 EL'l'Ui'Flilem o. urealaILo: as Points IN OUT NIU (US COMMENTS Food-cantata smut-er. designed. constructed. maintained. installed. located 2 Noumea?contact surfaces desrgned. constructed. maintained. installed, located 1 Dishwashing Iaall?lies approved design, adequalely constructed. maintained, installed. located 2 17 Planet chemical teal tilts measunrig devices for oh, thermal strips. and logs are present Temperature and D54 gauges are accura'ln 1 inn-Hares and Is ore-?ushed. scraped. and soaked trip.- to cleanmg 1 Wash and arise mug-r is clean, and at proper temporalure 2 1: Sam nil-en rinse ware! - chain-cal; Prop-c: urination a! food contact surfaces impugn lemperalure. memvcal corcenlreecn, 20 exposure l-rne Ior emomer: and Uta-Milli 3 Magma IEROTECTTON FROM CONTAMINATION Points IN OUT I'll/'0 NIA CD5 COMMENTS Wm doll-is stored clean anti cry or In a sanitizing solution 3 3 need to store properly between use. Do not use all purpose cleaner spray on prep cou Food-comer: surfaces ol utensils eou'ipn'icnt clean 2 Nonlo-ao-oontm surfaces ol u. Hans-Ls 5- ecupmenl {Jean 1 24 r-Ir- ?-r-I-Iul i? slot-3'31: narlcurig, prg??m .muimnamli 2 it Single service articles are Horn an approved scurce. are stored. handled, dtw??11:d_ used and mason-d at a manner 1m: prevenls conlanuruillon. 1 No ro?uso all sing?.- sew-co for load or die-mica slorage I Moon-tn IWATER a DISPOSAL Points IN OUT Nfo Ill/A C05 It Waler su poly II Ire-m an approved source and water supply is sutiuiznl for lh-e operations intended 3 3: Patrick will Have this Information 5??59 ?Film-?9: Pint-WP of waste water In loom-cc disposallac-Irlies (re slop 5m; 1} 3 "even-In ?Wm" wr in our NJri cos Location, insta'I-llron. mamlomncr- lie cupping Lancet; Beating papa). .1. hp 2 ,1 COMMENTS 9'th "5?35? U055 carnelian. go. back?tm 3 I . :r Spray at the dishwasher was below over?ow rim. COS fidnutrliiu In?l'?di candy dc :lgl'm'J 3 I 25 Com! St th, MA 02360 Tel: 505747?1620, Extension 10113 67.51%? Townvo? Plymouth Public Health Department . RETAIL FOOD INSPECTION FORM Torlel lacilmcs: properly constructed. self closing doors. fixtures in good repair. SUpplicd with soap and towels in dispensers! hand- drying devices, cleaned, covered sanitary rccepticle. handwash signage presertt.?TorleI have doors and I10 Open Into areas where food is exposed to airborne contamination and are adequately separated lrom food 2 omcessino and Sloraqe areas at FACILITY AND GROUNDS Point: IN OUT NIO NIA COS Sul'?cernt wavered Lrash recepbcles present In adequate number. leali pro-of, insectlrodent prool, emptied adequate frequency. 2 clean Outside premises are free from trash, etc, free at harborages, breeding places tor rodents, insects, and other pests. Outside areas (roads, yards. disposal systems] provide adequate drainage and do not constitute a source of contamination Controlled mneralion 2 Doors, windows, and other openings are protected to eliminate entry by insects. rodentsl'pests No evidence of pests present 3 mm FLOORS, WALLS a. CEILINGS Points IN our No NIA (05 COMMENTS Proper floor construdion. proper floor covering installed. ?oors graded With drained as required, ?oor and wall juncture covered Floors in dead repair and clean Duslless cleanino methods used as needed 1 a: 37 Walls, ceilings, attached equipment, properly constructed, good repair. dean Wall 5 ceiling surfaces as requrred Dustless 1 doanin methods used as needed 33 Adequate lighting provided lot sullicicni candle light Fixtures properly shielded or use of shatter probe bulbs 1 39 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamrnalion by dust. . andfor other airborne substances 1 I Dust fans so dust IS not spread through laCIllty. 40 Locker rooms. employee changing areas. provided. located to prevent contamination of production areas, and used for slorage or employee personal items. properly equipped and property ventilated Dressing rooms are maintained in good physical repair, 1 w?-D?lH-l 34; I: . ?aura :1 .3 .1191- x. ??jwid? gm; 41 cleaning supplies are used in a sole, elledive manner Hazardous materials are kept in their original containers and stored 5993?? "um raw materials 3 it Store chemicals in correct storage area not on shelves. Corrected. Premise:- mainlarned free at litter. unneccsa-?p Item and amt-Jigs. disarm-,3 maintenance equipment taupe",- armed, 3: Separation or maintenance rooms and equipment. laundry lacilities by panibon 1 Solled linens properly stored 1 mwa-ptn RESPONSIBLE PERSON IN CHARGE Points IN OUT N/o COS COMMENTS Clef-Iliad Foo-d Protection Manager 3 PIC Is knowledgeable and understands sanitaryI controls demonstrates competence 2 mm HIGHLY SUSCEPTABLE POPULATIONS lpuinrsl lN I cos Pastuenzed loads used; prohibited foods not offered. I 3 I I I Mariam Anomves [Poinrsl IN IDUT [N/o I cos 43 Food additwesrappmved and property used I 3] I I): EQUIPMENT AND UTENSILS Polnts IN our NIO NIA cos COMMENTS men all: and risque-roan: are cleaned and sanitized at Intervals that are frequent enough to aicid contammaacn or icon products 2 1: Instruments and controls used Ior measuring, regulating, or recording temperature. pH. acidity. water activity, or other conditions are accura1e and adequatel maintained 1 :i (a la" Fri-thins or t?LIIlim'mL .rermom: cm an: at or so use: [or antra- ct an.- aqumze an: anecdotal; ma'ma?m" 1 at creating a log ITEM ILICENSURE Points IN OUT mo NIA cos COMMENTS 52 mm is currently licence-c by the regulatory aumanty 9.35mi; 1 mm 1CONFORMANCE WITH APPROVED PROCEDURES 1 pt [or all) Points IN OUT NIO NIA C05 i?xllL-IL-m arm 1 1 (?nl?rmliImqic with ?inlun! pinccuc'l 1 1 Jr I null [-l?ll 1 Procedures for responding to mrluling 1i: Illudl events 1 1i [pornisl IN IOUT lN/o l? cos COMMENTS annulled records available: shellstocic tagsmarasitc destructionf?me As a Public Health Control, required logs Court St Plymouth, MA 02350 Tel: 508-747-1520, Exterrsion 10118 ITEM . - -. Townrof?jymouth Public Health Department - RETAIL FOOD INSPECTION FORM ntcono cuttxusr - 1 Water quality and suppti records grease trap dcaning record, ansul system cleaning records and Iags current, Fire 5 we?. 1 no tor: for ansul system and hood cleaninlz. Fire department noted this In past repair. Employee training records Temperature control records Equipment monitoring and maintenance records Calibration records I Sanitation records :It Required Logs; Time as a Public Health Control, Receiving Temperature, parasite desmion it no one veri?es but is put directly into walk ins. Pest conlrol records at it Variance request and approval, Time as a Public Health Control Procedure Inspection records (e incoming product, facility produaion area) It ITEMS OBSERVED IN: In Compliance Critical items Observed (Primary. Fri-nary Foundation) 1 OUT: Out of Compliance Non-Critical Items Observed [Primry Fmtion.00rul 2 Not Observed Total Non-Compliant Observations 3 Not Applicable COS: Corrected on Sight Score 94 R: Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation I 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suSpension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by [his order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: Food Service Director Patrick Van Cott phone number 503830?404 No retail store from cafeteria, a separate retail store from the school system Games have concession and cook at the concession stand Management does a good job at this location. We spoke about a low opportunities for improvement. Cold racks and hot racks separate, hydration station, and sanitizer control and use. Will return in 2 weeks to see corrections completed. Plymouth, MAOEBGO Tel: 508-74? 1620, Extension 10118 Diagrams: Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Plymouth North High School Address: 41 Obery St, Plymouth, MA 02350 Phone: 508-830-4400 Last lnsp. Date: 12/712015 Purpose of Inspection: Routine Type of Establishment: Retail Food, Milk, Food Production Risk Category: High Time It 10:45 Time0I11:4S Inspection by: Marcia Lee Signature: PIC Received by: Lisa Stone Signature: Managers Emai Permit Holder: Plymouth School Department Lisa.stone@plymouth.k12.ma.us Foodhorne illness risk factors are important practices or procedures Identi?ed as the most prevalent contributing factors of foodborne illness and/or injury. Public health interventions are control measures used to prevent such foodborne illness and/or injury. Types of Inspection: Routine, Re?Inspection, HACCP, Pre?Operation, Suspect Illness, Complaint, or Other -Reinspection Date: License/Permit Number: milk 2166. Retail 2160. Food 814 Corporate Em; il: a.us ITEM Phone-uh: SOURCE or soon IPoints] IN our Irv/o cos COMMENTS 1 Approved source tor food, wolananc Ice; ma?a-55m, honed-uncalled I 3' I FOOD PROTECTION Points IN OUT NEG NIA COS COMMENTS Potenti Ily hazardous food meets temperature requrrernents during storage, preparation, cooking. cooling, holding, display, samce and trans 3 Adequate fat: ties to mairrtain product temperature, thermometers provided 3 provided and. accurate, prop-city cairbralad 1 Potenti hazardous food property thawed 2 Unwrapped or potentially hazardous food not reserved 2 Food protected during storage, preparation, display, service transportation Food containers stored o? ?oor Washing fruits and ve mamas 2 .-. Do not use a chemical vegetable rinse for fruits and vegetables. Ordered. Handling of load and ice minimized No bare hand contact with ready-to-eat foods, proper utensils used, or approved alternate malhod properly Intro-tea 3 In use food dispensing utensils property stored 1 thlraphs ENPLOYEE HEALTH Points IN OUT NIO NIA C05 COMMENTS Management awareness; written health policy present Proper use of reporting, proper restriction 6. exclusion for reportable diseases No discharge from eyes nose, or mouth observed 3 12 Proper eating, tasting, drinking Good hygienic practices, proper handwashing and glove changing observed, smoking restricted 3 Proper hair and beard restraints are worn correctly. clean uniforms. kitchen whites. and aprons. 1 Phoma'lnhs EQUIPMENT 5 UTENSILS: DESIGN.CONSTRUCTION A INSTALLATION Points IN OUT Hm MIA COS COMMENTS Food-contact surfaces designed, constructed, Installed, located 2 It NOnfood-mntaot surfaces designed, constructed, maintained, installed, located 1 Dmhing fee-lilies approve-d design. adequately constructed. mmtulnud. Installed. located 2 1: Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present Temperature and psi gauges are accurate 1 It it Tablewares and Equipment is pro-flushed, scraped, and soaked prior to cleaning. 1 1 Wash and rinse water is clean, and at proper temperature 2 Sanitization rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature, chemical 2? concentrator-I I: sure llrl'lI'l to: uiorr-orli om! utensils 3 PROTECTION FROM CONTAMINATION Points IN OUT NIO NIA COS COMMENTS Wiping cloths properly stored clean and dry or in a sanitizing solution 3 Food-contact surfaces of utensils equipment clean 2 Nonfood?contact surfaces of utensils 8. equipment clean 1 Proper equipmentlutensils storage, handling. to prevent contamination 2 15 Single service articles are from an approved source, are stored, handled, dispensed, used and disposed cfin a manner that contamination 1 It No re-use of single service containers tor food or chemical storage 1 Photoviphs WATER SUPPLY DISPOSAL Points IN OUT NIO NIA COS Water supply is from an approved source and water supply I: aulftceon?l for the operations intended 3 pam?k Wm Hm this information Sewage disposal approved Proper disposal of waste water! In acpmvucl (In slop sunk-5} 3 Phemcrivhs PLUMBING WT lN OUT NIO NIA COS Location, installation, maintenance (ie dripping faucets, leaking pipes, improperly wasting pipes) 21 COMMENTS Plumbing installed preventing cross connection, back siphonage, back?ow 3! .11 dia?wdarcr was smow CUS- 25 Court St. Plymouth, MA 02350 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Adequate handwashing facilities, easily accessible, designed, installed 3 32 Toilet facilities: properly constructed, self closing doors, ?xtures in good repair, supplied with soap and towels in dispensers! hand-drying devices, cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from 2 tr Photolraplls FACILITY AND GROUNDS Paine IN OUT Nlo NIA COS Suf?ceint covered trash recepticles present in adequate number, leak proof, insectlrodent proof, emptied with adequate Ire uenc clean 2 Outside premises are tree from trash. etc tree at harborages, breeding places for rodents, Insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled mommatian 2 Doors. modems. an: other conning: are ordtoctcd to entry by Insurer. rodent Ernest: No evidence of post: armor-t 3 It Photographs FLOORS, WALLS CEILINGS Points IN OUT NIO NIA COS COMMENTS Proper ?oor construction. proper ?oor covering Installed. ?oors graded with drained as reqwred, ?oor and wail Iuncture covered Fem all and eaten Dudtloes clean method; was as needed 1 I Walls, ceilings, attached equipment, properly constructed, good repair, clean Wall 8 ceiling surfaces as required Dustless 37 1 stem-Irma thermos used as needed Adequate lighting provided for suf?cient candle light Fixtures properly shielded or use of shatter prood bulbs 1 39 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, andtot other airborne substances 1 40 Locker rooms, employee changing areas, provided, located to prevent contamination of production areas, and used for storage of employee personal items properly equipped and properly ventilated Dressing rooms are maintained in good physical repair, 1 41 Insecticrdes and are used and stored so as to prevent contaminatron of [cod Items Detergents, sanitizers and other cleaning supplies are used in a safe, effective manner Hazardous materials are kept in their original containers and stored sopmale from raw mtormls. 3 . Premises maintained tree oflitter, unnecesary items and articles, cleaning maintenance equipment properly stored, 1 Separation of maintenance rooms and equipment, laundry facilities by partition 1 Soiled linens properly stored 1 Phalnrranhs RESPONSIBLE PERSON IN CHARGE Point! IN OUT NIA EDS COMMENTS Certi?ed Food Protection Manager 3 PIC Is knowledgeable and understands sanitary controls demonstrates competence 2 Ir ITEM mum-Is HIGHLY SUSCEPTABLE POPULATIDNS IPointsI IN [our INIO INIA cos 47 Pastuerized ioods used; prohibited foods not offered I SI I I I I Photographs FOODICOLOR Aoorrists IPointsI IN IDUT IMO INIA cos Food additiveszapproved and property used I 3I I I I: I Fhotolriplls EQUIPMENT AND UTENSILS Points IN OUT NIO NIA COS COMMENTS 43 All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food roducts 2 3: Instruments and controls used tor measuring, regulating, or recording temperature, pH, acidity, water activity, or other conditions are accurate and ads uatel maintained 1 . con- ro Lizard: are accurate and adequately 1 Photographs ?census: IPointsI IN Iour Nlo I cos COMMENTS 52 Film is currently licensed by the regulatory authority having jurisdiction I 1I I I I I Plume-pus CONFORMANCE WITH APPROVED PROCEDURES (WT 1 pt for all) Points IN our NIO NIA cos Alla at Ccru?' catc 1 2 Consumer Advisorv Posted 1 liancc with vmtance?soccializcd oroccss/HACCP 1 i: 1 Ir 1 F.O.G. Local BOH Regulation 1 Procedures for responding to vomiting diarr' heel events 1 ITEM I Photo-ram Iatoonos IFolnuI IN {our INIO cos 26 Court St. Plymouth, MA 02360 Tel: 508?747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 54 _Recuired records available: shellstock tags. parasite destruction.Time As a Public Health Control, reauired logs 11 ITEM RECORD CHECKLIST Water quality and supply records, grease trap cleaning record. ansul system cleaning records and tags current, Fire extinguisher tags current no tag for ansul system and hood cleaning Fire department noted this in past report. Email sent to Patrrick on this item. Employee training reco Temperature control records Equipment monitoring and maintenance records Calibration records Sanitation records Required Logs: Time as a Public Health Control. Receiving Temperature. parasite destruction Pest control records Variance request and approval, Time as a Public Health Control Procedure lnspection records (a . incomin product. fa _ty DroductEm areal ITEMS OBSERVED Critical Items Observed (Primary. Primary Foundation) Non-Critical Items Observed (Primary Foundation, corn) Total Non-Compliant Observations Score 98 OUT: MIA: cos: In Compliance Out of Compliance Not Observed Not Applicable Corrected on Sight Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by 3 Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten [10) calendar days of receipt of this order. Additional Notes.- Food Service Director Patrick Van Cott phone number 508-830-4474 No retail store from cafeteria. a separate retail store from the school system Games have concession and cook at the concession stand All noted violations taken care of,some items on order. Hood still needs tag. Greatjob with addressing concerns by manager and staff. 26 Court St. Plymouth, MA 02360 Tel: 508?747?1620, Extension 10118 Diagrams: THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Type??f Inspection Ill Rouline ame a gge 0 para icn[s} mot/vi Hill Sc kid yr} Ralf) FoddOServirtJe Retail Re-inspection Residential Kitchen Previous Inspection Add I I use tom rm Mobile Date: Temporary El Pre-operation Telephone Q) ?:23 9381-1 COLD Caterer Suspect Illness El 5 Owner QC HACCP YIN El Bed 8. Breakfast General Complaint Ch lo 7 erson In arge(P Al 0Q L, Inllne Inspector dirk/lm KIA: 9 Out: PermitNo. DOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non- compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Ant -0hok ng 590.0095) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590-009 (F) action as determined by the Board of Health. ?mg? 590-009 (G) FOOD PROTECTION MANAGEMENT El 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH El 2. Reporting of Diseases by Food Employee and PIC 12. Prevention of Contamination from Hands l: 13. Handwash Facilities PROTECTION FROM CHEMICALS [j 14. Approved Food or Color Additives D15. Toxic Chemicals RE CONTROLS (Potentially Hazardous Foods) 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE Cl 4. Food and Water from Approved Source Cl 5. ReceivingICondition 6. TagsIRecordslAccuracy El 16. Cooking Temperatures El '17. Reheating El 7. Conformance with Approved ProceduresIHACCP Plans El 18' Cooling PROTECTION FROM CONTAMINATION [j 19' Hm and COM Holding 8. El 20' Time AS a Health Control - . . . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 9. Food Contact Surfaces CleanIng and SanItIzmg El 21' Food and Food Preparation fm HSP 10. ProperAdequate Handwashing CONSUMER ADVISORY 11' G??d Hygienic Practices El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 23. Management and Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: Inspector's SigIInturcjj/JL l?rinl: .fr 3% p1 int: 514 l?achoIiPnges FORM 734A AM SULKIN CO CHARLESTOWN MA L: @3015 THE COMMONWEALTH OF MASSACHUSETTS JOWN on CITY OF ?Pl Li] mrniijfbl . Establishment Name?r lull maLl?d Sb Date: fg/ 1' 7 Page: 9? of; Item Code C-Critical Item . . Date No. Reference R- Red Item Veri?ed PLEASE PRINT CLEARLY twp?(me: ?law; 5 1 tart-"val xiv-=1 "var" A 1' 11,4? ?5 - 9: (443? ?16; no.2 Id kJ pm' aim puffs?) Wit/.1, IIW I Xi'? Nil?2h 11,1 Ii 'rF-l - (a 73:: LL. f-kr'v ?f mm i- Rgx/gf?f?L/QJ D. Fifi; I Discussion With Person in Charge: Corrective Action Required: No El Yes Voluntary Compliance El Employee Restriction] Exclusion Re-inspection Scheduled Emergency Suspension Cl Embargo El Emergency Closure Cl Voluntary Disposal Cl Other: Form 734 8 AM. Sulkin (30., Boston. MA Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM NAME: South Htah th?al ?mo in: 12:01- T-rr'r Owl-30 2.319 Foodborne illness rl5k factors are important practices or procedures Lon: pond Road Inspection by: Marcia lou- identified as the most prevalent contributing factors of foodborne Pita?: 503.224.7005 illness and/or injury. Public health interventions are control measures I . Lat! lnsp, 93?: 51301-1? PIC Reteived by: Kimma tapes .1 used to prevent such foodborne Illness and/or injury, Purpose oi Impec?on: Routine Signature anru? ?I'vpes Routine, lie-Inspection, HACCP, Pre-Operation, Type a. ?nun?, ment.? F595 Establishment Managers Email: ut Suspect Illness, Complaint, or Other mm {Mtg-11W: Form: Holder: Town of Plymouth Schools Relnspection Date: Utensef?ermit Numb er?i?- and 521 Food Ettahilshn?lent: Retail Food 325: Mill: 823 Cmporate Ema-l. Pvancoqulvmouth.k12.rna.us _1i"29i?2019 ITEM Fijian Points IN OUT HID NM (05 CO MMENYE 1 Approveo source for load. water and ice wholesome. nonadulieraleo 3 Human [moo PROTECTION Points IN our Nlo MIA cos a COMMENTS Foods were unable to maintain temperature because utilizing a hot holding equmeiit Foods were in plastic containers placed In a metal pan on top cl 3 thin strip of cubt?5 Manager will replace With metal containers submerged into .in ice bath to product temperature, and rotate into told storage to maintain temperature control during lunches Protiens ham 7, turkey 50 O, Chickt?li all out of temperature Food was discarded and t. lhave new product 3 3 - tomorrow starting, With the new routine 3 Thermometers prowdod and accurate, properly calibrated 1 Potentially hazardous food property thawoo 2 Unwrapped or potentially hazardous food not reserved 2 1: Food i: m: - wrest 515 J7 ?31 $1933.? 5 3" ??95 Some food products stored on the floor Or on improper shelves/storage not ?(Jean?s 1 - designed for the Intended use. NO vegetable wash used . . 3 In use food dispensing utensils properly stored 1 ITEM mug-pm HEALTH Points IN OUT N10 NIA COS COMMENTS 11 . orseases No oiscmroe eyes nose or ooseneo Needs the written school policy 12 Proper eating last rig :rin'rting Good lay": practices proper liariowashing and glove changmg observed amour estiicteo 3 13 Proper hair and heard restraints are worn correctly, clean uniforms, kitchen whites. and aprons 1 Printer-oh: EQUIPMENT 3. UTENSILS: a. INSTALLATION Points IN OUT NIO NIA C05 COMMENTS Food-contact surfaces deogneo, constructed, maintained Installed, located 2 NonYOOd-Conlad surfaces dBSigned. locale? Heed proper dunnage racks to replace wood pallets in the kitchen and walk in cooler, snack bar to keep food 6" off the floor and made of a non impervious, easily 1 1 :Ieanable, durable surface Dishwashing Iacalities approved design. adequately constructed. maintained. located 2 I: proper chemical test luts, measuring detrices for ph, thermal and logs are present Temperature and DSI gauges are accurate 1 I need thermal strips for dishwasher, Tablewares and Equtpment is pre-?ushed. scraped, and soaked prior to cleaning 1 Wash and I'll?tic water :1 clear._ and .11 propel temp-ennui: 2 ion rinse (hor waiter - chemical) Proper sanitization ol food contacl surfaces "trough temperature chemical concentraiion exposure iime [or equipment and uteri-sum 3 log lilled out at 200 but no active sanitizer present in sink or summer hauls-n ITEM I Plume-pm IPROTECTION FROM CONTAMINATION paints in OUT Nlo NIA cos 3 COMMENTS ioing dams properly sloreo clean and or; or ii?. a saniliaing solulion 3 A Food?contact surlacos oi utensils it equipment clean 2 It ?half?! cloths found on to outer; soiled no: in sanitizer. Corrected. 23 Montana-contact surfaces of utensils a equipment clean 1 1 Proper equipmentlutensils storage, hanoiing. to prevent contamination 2 26 Court St Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Single service arucies are tram an approved source are stored, handled, dispensed used and disposed at in a manner that 25 tire-aunts 1 25 Na re-uso or single service containers tor food or chemical age 1 ITEM pruning-uh: WATER SUPPLY a. DISPOSAL Points IN OUT NM COS Hater suppiy is from an approvr-i?. ant: .s'uler supply ?5 su?t Cit-n: tor the 0:31;. "ens intended 3 I COMMENTS Sewage dispose: approx ed Hepcr ClprI-dl 0 waste wa1er unapproved disposal-3 3 PLUMBING W'l' OUT NIA COS Location, installation, maintenance (ic dripping tnucets, leaking pipes, improperly wasting pipes) 2 1: COMMENTS Plummng insIaJed prmenhng croso conduction hack smhonagu. manor: 3 Rcequale handrrashmg iatljlics cuss acct-sable deagncd, installed 3 it Toilet faalities: properly constructed, sellI closing doors, ?xtures in good repair, supplied soap and towels in dispensers! hand- devices. cleaned covered sanitary dispoal recepticle, nandwash signage present Toiie1 facilities have sell-closrng doors and doors do not open into areas where load is exposed to aimome contamination and are adequater separated from tood processmg and storage areas 2 ITEM PMrornPhI AND GROUNDS Polnls IN OUT N/o ill/A cos 33 Sulfic?elnt covered trash recepticles present in adequate number, leak prodl,insect1rodent prcui emptied With adequate lrequency clean 2 Outside premises are tree from trash etc free of hamorages, breeding places for rodents, insects. and other pests Outside areas (roads, yards, disposal systems) prowde adequate drainage and do not constitute a source of contamination Controlled incineration 2 Photon-rah: IFLDORS, WALLS a ceruucs Points our two NIA cos 35 Proper ?oor construction, proper ?oor covering Installed, ?oors graded drained as required, floor and wall Junclure covered Floors In repair and "clean Dustless cleanino methods used as needed 1 - 37 Walls ceilings, attached equipment property constructed good repair dean Wall ceiling surfaces as recurred Dustless 1 methods used as needed Adequat lighting provtc'ed tar sutticzent candle light Futures property shielded or use at sh :ter prood bulbs 1 Air quality and ventilation are adequate to remove excessive heat for equ1pment and rooms and prevent contamination by dust andror other airborne suostanccs 1 Locker rooms, employee changing areas, provided, located to prevent contamination oi production areas, and used for storage of employee personal items properly equmped and properly ventilated Dressmg rooms are maintained in good physical repair, 1 3 . Premises maintained tree of tar, unnecesary items and articles. cleaning maintenance equipment propeny stored 1 Sepera at maintenance rooms and equipment, laundry facilities by partition 1 Soiled linens properly stored 1 IRESPONSIBLE PERSON CHARGE pain? OUT NM cos COMMENTS 45 a: Protector mm 3 PIC is knowledgeable and understands sanitary controls demonstrates competence 2 ITEM HIGHLY SUSCEPTABLE POPULATIONS Points IN OUT MIA C05 47 Paslucvizcu toads used, loads not cite-red 3 ITEM Photograph: lsoonrcomR ADDITNES Points IN OUT NIO NIA C05 43 Eoz): add-nae; and wont-r1; used 3 EQUIPMENT AND UTENSILS IN OUT NIO NIA C05 COMMENTS All u1?n5I $ and computer? art: cleaned and sanitized at intervals that are trequent enough to avoid contamination oi lend products 2 50 instruments and controls used tor moasunng, regulating, or recording temperature, pH, acidity, water activity or other conditions are accurate and adequate maintained 1 a ram ion records or equrpment thermometers. and other upvrces lor controt or nazaros are accurate ant: adequately 1 26 Court St Plymouth, MA 02360 Tel: SOB-T474620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM iPD'??i i him i C05 Iirm IS currently licensed by the regulatory authority havrng Jurlsdiction I I I I CONFORMANCE WITH APPROVED PROCEDURES (WT 1 pt roraiu pa 5. OUT NED NIA COS Incal BDH Regulation Hap-H9541.- Procedures for responding Io vomiting diurrheal Maintnenca has proceedure to clean, post policy for workers. ITEM I IRECORDS [poinrsl lN [curl N/ol cos I_Reauired records available: shellstock tags, oarasrte destruction.Tirne As a Public Health Control. reouired logs I 1 I I ITEM "mu-vi? RECORD cr-Iccxusr Water quality and suppty records grease trap cleaning record ansul system cleansng records and tags current Fire tags current Ho ansul system tag. no rut-crept for cleaning: hood to roof. no grease trap rucom Employee training records Temperature control records Equipment monuorrng and records Calibration records XIIMXX Sanlialron records Requn?ed L0951Timo as a Publm Conlrol Recon/mg Tempernlure. parasrie Done In house no CPO - Should have record In of?ce of pest bows, Izsucs. Pest control records Variance requesl and approval Time as a Push: Heath Comm! Procedure 1: Inspection records i5 Incoming product laCIlrty, production area} ITEMS OBSERVED Critical Items Observed (Primary. Prmury rmmum) 1 Non-Critical Items Observed (Primary Found??:00, Com) 3 Total Non-Compliant Observations 4 Score: 96 IN: In Compliance OUT: DutofCompliance Not Observed NM: NotApplicable COS: Corrected on Sight R: Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations ofthe Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code This report, when signed below or delivered using electronic mail, by a Plymouth Pubiic Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board ofHealth hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: Spoke about the new code and where to find the exclusions so in house procedure may be written by school system. Also. about diahreal and vomiting procedure to notify staff on what to do until the maintenace comes in to clean Manager very knowledgeable and does a good job some items for retraining as they are people issues. Facility is very clean and well marntained The hot holding unit is not utilized. perhaps another location might benelit from it and have a cold unit replacement. 26 Court St. Plymouth, MA 02360 Tel: SOS-71174520, Extensron 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM NAME: Plymouth South High School Tim! Ire: 11ml: iimr Oil!?- 31:? Foodborne illness risk factors are important practices or procedures Address:d9t:t Long Pond Road inspection by: Macia lee identi?ed as the most prevalent contributing factors of foodborne Phone: 50872243005 Slgneture: ness and/or injury. Public health interventions are control measures Last lrup. Date: #3011? PH: Ranked by: Kimmatie Lopes used to prevent such foodborne illness and/or injury. Purpose o?l Inspection: Routine Signature.- Types of Inspection: Routine, Re?Inspection, HACCF, Pre-Operation, Type of Establishment: Food Establishment Managers Email- Itlopes?piymouth.lt12.ma.us Suspect Illness, Complaint, or Other Risk Category: High PIrml'l Town at Plymouth Schoolo Reinspection Date: Licensef?errnit Number?zd and 321 Food Establishment; Retail Food 315; Milk Corporai'e Email: Pvancott@cilyrnouth.lt12.ma.us -1/29/2019 ITEM MSOURCE OF FOOD IPointsI I our Nro NIAI cos cOiviMENTs Antarctica source for Poo-d. ?tenant! nco: mime-rm. mnotiultoraloo Photographs FOOD PROTECTION Points lN OUT MIA COS COMMENTS Potentially hazardous food meets temperature reqmrements during storage. preparation, cooking. cooling. holding, display, Foods were unable to maintain temperature because uti zing a hot holding and transportation equipment Foods were in plastic containers placed in a metal pan on top of a thin strip of reusable ice cubes Manager will replace with metal containers submerged into an ice bath to maintain product temperature, and rotate into cold storage to maintain temperature control during lunches Protiens ham 5? 7, turkey 60 0, chicken all out of temperature Food was discarded and will have new product 3 tomorrow starting with the new routine Adequate lac as to maintain product temperature. thermometers provided 3 Thermometers pron-idea and accurate, property estimated 1 3: Pete hazardous food property thawed 2 Unwrapped or mlontsaTtr hazarooun too-d not reserved 2 is Food protected durlng storage. preparation. display, servrce a transportation Food containers stored orr ?oor Washing fruits and Some food products stored on the floor or on improper shelves/storage not VBQEIablas 2 as designed for the intended use. NO vegetable wash used.Corrected Handling of food and ice minimized No bare hand mntact with ready-to-eat foods. proper utensils used, or approved alternate root not! prop-ont- tcillowod 3 It In use food dispensing utensils properly stored 1 :It Phatouriphs EMPLOYEE HEALTH Points iN OUT cos Management awareness; written health policy present Proper use ofreporting, proper restriction a exclusion for reportable diseases NO disoha from a nose. or mouth observed. 3 it Needs the written school policy 12 Proper eating. tasting. dn'nking Good hygienic practices. proper handwashing and glove changing observed, smoking restricted 3 Proper hair and heard restratnn are worn correctly, clean uniforms, kitchen whites, and aprons. . EQUIPMENT 5. UTENSILS: DESIGN.CONSTRUCTION 5 INSTALLATION Points IN OUT him NM 005 COMMENTS Food-contact surfaces designed, constructed, maintained. installed. located 2 15 NonfOOd-wmacl surfaces OBSiQnedr constructed. maintained. installed. located Need proper dunnage racks to replace wood pallets in the kitchen and walk in cooler, snack bar to keep food 6" Off the floor and made Of a non impervious, easily 1 1 cleanable. durable surface. thwaahing laciilli'tn approved design, adequately constructed, maintained. installed. touted 2 17 Prop-er chemical too kits, measuring devices for ph. thermal strips. rind logs are present T?nrpormwu and pat gauges are uccurato 1 need thermal strips for dishwasher, Tablewares and Equipment is pro-?ushed, scraped. and soaked prior to cleaning 1 Wash and rinse water is clean. and at proper temperature 2 Sanitization rinse (hot water chemical) Proper sanitizalion of food contact surfaces through temperature. chemical log filled out at 200 but no active sanitizer present in sink or sanitizer concentration, exposure time for equipment and utensils 3 bottles Corrected PTIOT at: new FROM can rat-narrow Points Photirilra OUT MID MIA COS COMMENTS Wiping cloths properly stored clean and dry or In a sanitizing solution 3 Food-contact surfaces of Utensils 5 equipment clean Wiping cloths found on counters soiled not in sanitizer. Corrected. Nonfood-Oontact surfaces of utensils 8; equipment clean Proper equiprnentlutensils storage. handling. to prevent contamination Single service articles are from an approved source. are stored, handled, dispensed, used and disposed of in a manner that revents contamination No re-use of single service containers for fOOd or chemical storage 1 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 53 ITEM thlraphs WATER SUPPLY 8 DISPOSAL Point: IN OUT HID NIH COS Water supply is from an approved source and water supply is suf?cient for the operations intended 3 COMMENTS Sewage disposal approved Proper disposal of waste water in approved disposalfacilities (ie slop sinks) 3 Phebl?nhi PLUMBING WT IN OUT NIB NIA C05 Location, installation, maintenance (ie dripping faucets. leaking pipes. improperly wasting pipes) COMMENTS Plumbing installed preventing cross connection, back siphonage. back?ow 3 Mei-quote nnmwaamng easin- accession). cresgnc-o, installed 3 32 Toilet facilities: properly constructed. selfclosing doors, ?xtures in good repair, supplied with soap and towels in dispensers! hand-drying devices. cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from food processing and storage areas. 2 3? FACILITY AND GROUNDS Points IN OUT MA COS Sul?ceint covered trash recepticles present in adequate number. leak proof, insecti'rodent proof, emptied with adequate 2 Outside premises are free from trash, etc . free of harborages, breeding places for rodents. insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled incineration 2 Doors, windows, and other openings are protected to eliminate entry by insects. No evidence of pests present 3 FLOORS, a. CEILINGS Point: IN OUT Ivro WA cos COMMENTS Proper ?oor construction. proper ?oor covering installed. ?oors graded with drained as required, ?oor and wall juncture covered Floors in and re air and clean. Dustless cleanin methods used as needed 1 37 Walls, ceilings, attached equipment, properly constructed, good repair. clean Wall ceiling surfaces as required Dustless 1 clear" method: use-d as needed Adequate lighting provided for suf?cient candle light Fixtures properly shielded or use of shatter prood bulbs 1 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, andi?or other airborne substances 1 40 Locker rooms, employee changing areas, provided. located to prevent contamination of production areas, and used for storage of employee personal items property equipped and properly ventilated Dressing rooms are maintained in good physical repair, 1 Insecticides and rodenricioes are used and stored so as to prevent coniaminaiion olfood iiems Detergents, sanitizers and other cleaning supplies are used in a safe, eltective mariner Hazardous materials are kept in their original containers and stored separate from raw materials 3 Pioneers: meant-mes tree at litter, unnecessary Home and articles, cleaning mainlorlm'lco ?Lawton! gloomy stored, 1 5: Separation ofmaintenance rooms and equipment, laundry facilities by partition 1 Soiled linens properly stored 1 thlraphs RESPONSIBLE PERSON IN CHARGE Point IN OUT Nit] COS COMMENTS Certi?ed Food Protection Manager 3 PIC is knowledgeable and understands sanitary controls demonstrates competence 2 ITEM Photo-ram HIGHLY SUSCEPTABLE POPULATIONS IPointsI Fastuerized foods used; prohibited foods not offered I 3 I I I I ITEM Photnlrinhs FOODICOLOR Aoomves IN I OUT I NM rule I cos 43 Food additiveszapproveo and properly used 'Wiv'? EQUIPMENT AND UTENSILS Points iN OUT NIO MIA cos COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food 2 it Instruments and controls used for measuring, regulating, or recording temperature. pH. acidity. water activity. or other conditions 1 it emiome ers, and other dances Tor cori?lrot OI hazards are accurate and adequately 1 ITEM ?Mum? UCENSURE IPoints IN OUT NIO COS COMMENTS 5: mm is currently tamed by lJ'Hi regulatory authority timing Jurisdiction I 1 :ii: ITEM puma?; CONFORMANCE WITH APPROVED PROCEDURES (INT 1 pt for all) IPointsI IN OUT I I cos Allergen Certi?cate 1 25 Court St. Plymouth. MA 02360 Tel: 508-747-1620, Ektension 10118 i Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM assi?ACCP F.O.G. Local eon R??on Procedures for ttsponding to vomiting diarrhcel events Maintnenca has proceedure to clean, post policy for workers. Corrected Photon: pits RECORDS curl HIAI cos COMMENTS Reunite-El records available: 5n eluloclt tags. parasite destructionJ-rne As a Public Health Control. required log; 1 Photographs RECORD CHECKLIST Water quality and supply records. grease imp cleaning record, ansul system cleaning records and tags current, Fire extinguisher tags current No ansul system tag, no reciept for cleaning hood to roof, no grease trap record Employee training records Torriporalum control records Equipment monitoring and maintenance records Calibration records Sanitation records Required Logs: Tlme as a Public Health Control, Receiving Temperature, parasite destruction, Shell?sh Done in house, no CPO should have record in office of pest boxes. issues. ?ndings. Pest control records Variance request and approval, 'I'Ime as a Public Health Control Procedure Inspection records {e incoming produoL facility_ pmduction area) ITEMS OBSERVED Critical Items Observed (Primary, Primary Found-lion) Non-Critical Items Observed (Primary Foundation, Core) Total Non-Compliant Observations Score: 98 IN: In Compliance OUT: Out of Compliance Not Observed MIA: Not Applicable COS: Corrected on Sight R: Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an Inspection today, the Items checked Indicate vroiatlons of the Plymouth Board of Health Food Regulation] 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in su5pension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: Spoke about the new code and where to ?nd the exclusions so in house procedure may be written by school system. Also, about diahreal and vomiting procedure to notify staff on what to do until the maintenace comes in to clean. Manager very knowledgeable and does a good job. some items for retraining as they are people issues. Facility is very clean and well maintained The hot holding unit is not utilized, perhaps another location might benefit from it and have a cold unit replacement. Manager wrote up Diahrreal and vo' ing procedure and posted it. Dunnage racks on order. Temperature solution everything noted in proper temp at this time. Will follow up at next routine inspection. Great controls in place! 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Diagrams: Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 508-747-1520, Extension 10118 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT of eration a ?he ection Ii?ouline Name Service [E/Rgtail Pie-inspection Residential Kitchen Previous Inspection (1 I Adress ch?f Ci pri-i?IrI 5 Level Telephone a; 3-H A Mobile Data: Owner Temporary Pre-operatlon SP r?h HACCP YIN Caterer Person in Chlar pic ,Tin'le Bed 8. Breakfast General Complaint 9 I ft; afaf?mi?ln: DHACCP Inspector (?1?ij Out: Permit No. El Other Each violation checked requires an explanation on the narrative pagets) and a citation of specific provision(s) violated. Non-compliance With: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Ann-Choking 590.009 (E) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco [3 action as determined by the Board of Health. Allergen Awareness 590.009 (G) FOOD PROTECTION MANAGEMENT 1. PIC Assigned Knowledgeable Duties EMPLOYEE HEALTH 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source El 5. Receiving/Condition 6. TagisecordslAccuracy of Ingredient Statements [:l12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS D14. Approved Food or Color Additives D15. Toxic Chemicals CONTROLS (Potentially Hazardous Foods) I316. Cooking Temperatures 17. Reheating 18. Cooling 19. Hot and Cold Holding El 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) [j 21. Food and Food Preparation for HSP T. Conformance with Approved ProcedureslHACCP Plans PROTECTION FROM CONTAMINATION 8. 9. 10. Proper Adequate Handwashing Food Contact Surfaces Cleaning and Sanitizing CONSUMER ADVISORY El 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board 23. Managementand Personnel 24. Food and Food Protection 25. Equipment and Utensils 26. Water, Plumbing and Waste (FC-5II590.006) 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other 22. Posting of Consumer Advisories Number of Violated Provisions Related To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.0001Federal Food Code. This report, when signed below by a Board Of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this orderl you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: Inspector?sSignature: I?riIIt: Kbif?l/?? K?/i Signatum: Print: Jr A zest/y FORM734A AM SULKIN C0 MA THE COMMONWEALTH OF TOWN 0R CITY OF pl mom Establishment Name: plb?imw 1436? Cu Date: Page: n- . ?6m Coda C?-?C?tlcal Item page "it. Reference R-Red Item PLEASEPRINTCLEARLY Verified Cit-Clio NA glut ?rm Aim-=behL CL mm amd :3 bot-LA?) Discussion With Person in Charge: Corrective Action Required: El No El Yes CI Voluntary Compliance El Employee Restriction! Exclusion El Re-inspection Scheduled El Emergency Suspension Embargo Emergency Closure Voluntary Disposal CI Other. Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Southside Fare (South High Culinary School) Time In: 10:45 Tim Out: 1343' DATE: foodlsorm- illness risk tacrors are Imponant practica or procedures Address: Long Pond Road Inspection by: Marcia Lee Identi?ed as the most prevalent contributing factors of foodborne Phone: 508-830-1036 Signature: illness and/or injury. Public health interventions are control measures Last Insp. Date: Received by: Chef Chris O'Connor used to prevent such foodborne ness andror Iniury. Purpose of Inspection: Routine Signature: Types of Inspection: Routine, Re?lnspection, HACCP, Pre-Operation, Type of Establishment: Food Establishment Managers Email: coconnor@plymouth k12 ma.us Suspect Illness, Complaint, or Other ?lsll: Category: High Permit Holder: Reinspection Date: Llconsa Permit "ambient-cod Establishment Corporate Email: 2/14/2019 ITEM SOURCE OF roop Points IN our Nfo NM. cos COMMENTS Approved source for food. werenand ice; Wholesome, nonadulterared 3 1 All foods must be stored in air tight. covered, labeled recepticles designed hr the intended use Foods must be labeled to ide?fy Make sure to label RTE with date prepared and expiration date. Foods ta ken from food by common name, date of production; date offreejng' thawing, prepamim' and expiration master containers/boxes must have expiration date transferred You have the right 1 A labels used on some items make sure uniform use ofthem Phatnnaplu FOOD PROTECTION Point: IN OUT NIB NIA (:05 COMMENTS Potentially hazardous food meets temperature requirements during storage, preparation, cooking, cooling, holding, display, service and trans rt 3 Adequate fac rtres to maintain product temperature, thermometers provided 3 Thonnomelpre prov?dod and accurate. property calibrated 1 at Potentially hazardous food properly thawed 2 or potentiality hazardous Foo-cl not reserved 2 Food protected during storage, preparation. display, service a. transportation Food containers stored off ?oor Washing fruits and veqetablas 2 it Handling of load and ice minimized No bare hand contact With ready-to-eat ibods, proper used, or approved alternate method oroperlv [allowed 3 In use food dispensing utensils properly stored Cooking ustensils were store in still water. Spoons for testing need handles 1 presented upward to prevent contamination of food contact surfaces. EMPLOYEE HEALTH Points IN OUT Nr'l'J NH. (205 COMMENTS Management awareness Proper use of reporting, proper restriction 8r exclusion for reportable diseases No discharge from eves nose or mouth observed 3 Proper eating, tasting, drinking Good hygienic practices, proper and glove changing observed, smoking restricted Two students observed drinking at hydration station but going back to work without 3 proper handwashing One used bare hand on onion Students observed wearingjewelrv including nose piercingjewelry, need proper Proper hair and beard restraints are worn correctly, clean uniforms, kitchen whites, and aprons. hair restraints EQUIPMENT a DESIGN.CONSTRUCTION 5 INSTALLATION Point: IN OUT Hro NIP. cos COMMENTS Food-contact surfaces designed, constructed, maintained, installed, located 2 slicer noted to have meat debris Nonlbod-oontacl surlaces designed, constructed, maintained, installed, located 1 Dishwashing facilities approved design, adequately constructed, maintained. installed, located 2 Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present Temperature and psi gauges are . accurate 1 It need log, all items are run through dishwasher except extra large Tablewares and. Equipment is pro??ushed, scraped, and soaked prior to cleaning 1 Wash and rinse water is clean, and at proper temperature 2 It Sanitization rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature, chemical 20 concentration exposure time for equipment and utensils 3 Miner-plus PROTECTION FROM CONTAMINATION Points IN OUT Nit) NIA COS COMMENTS Hm stored clean and or 'n a 33mm?? column 3 3 Stunt-inn erasures oSI'li?, :LIIchl wiping E?otn: left on pros: surfaces to W- et- food conta Food-comic! surfaces olu?lensrle a. equlprnan'l clean 2 2 Hood filters have accumulated dust Honbod-oenrar: surfaces of utensils eqquI-npnl clean 1 cooking line rear accumulated dust observed on back of cooking equrprne nt Proper equipmentlutensils storage. handling, to prevent contamination 2 2 25 service articles are from an approved source, are stored, handled, dispensed, used and disposed of in a manner that favorite centennial-on. 1 gle service containers for food or chemical storage 1 ITEM leriphs WATER SUPPLY DISPOSAL Paintsl Water supply is from an approved source and water supply is suf?cient for the operations intended 3 I I I COMMENTS 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 23 disposal approved Proper disposal waste water in approved slop sinks 3 ITEM PLUMBING 29 installation, maintenance (ie dripping faucets, leaking pipes, improperly wasting pipes) 3.3 installed 31 handwashing facilities, easily accessible, designed, installed 32 properly constructed. sell closrng doors, In good repair. supplied With soap and towels In dIspensersr? devices, cleaned, covered sanitary dispoal recepticle, handwesh signage present Toilet facilities have self-closing and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from cross connection, back ITEM Phalnlraphs FACILITY AND GROUNDS 33 covered Irsln prom! . . ern 34 premises are free from trash, etc tree of harborages, breeding places for rodents, insects. and other pests Outside (roads, yards, disposal systems) provide adequate drainage and do not constitute a source ofcontamination Controlled 35 windows. and other openings are protected to eliminate entry by insects, No evidence of pests present ITEM Pml?pl? FLOORS. WALLS at 35 ?oor construction. proper ?oor covering installed. ?oors graded with drained as required, ?oor and wall juncture covered 37 ails, ceilings, attached equipment, property constructed. good repair, clean Well a ceiling surfaces as required Dustiess 33 or use 39 qui?rty urn!- ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, 40 rooms. employee changing areas. provided, located lo prevent contamination of production areas, and used for storage ol items and ventilated rooms are maintained in BIB 50 as supplies are used in a safe, e?ective manner Hazardous materials are kept in their original containers and stored from raw materials maintained free oflitter, unnecesary items and articles, cleaning maintenance equipment properly stored, maintenance rooms and equipment. laundry lacilrties by partition linens properly stored RESPONSIBLE PERSON IN CHARGE Food Protection Mohag e: PIC is and understands controls demonstrates competence HIGHLY SUSCEPTABLE POPULAHONS been used, pron-Moo load-4 not offered Photographs additiveszapproved and properly used and are cleaned and sanitized at intervals that are enough to avoid contamination of food and controls measuring, regulating, or recording temperature, pH, acidity. water activity, or other conditions maintained licensed by tho thorI'ty having jurisdiction ITEM llhotegraphs WITH APPROVED pt with varianocfspecializod prooccs?I-LACCP 25 Court St. Plymouth, MA 02360 Tel: 508-747?1620, Extension 10118 COMMENTS Susan Martin #14250078 exp. 10/6/1021; Christopher O'Connor #10847031 COMMENTS COMMENTS on oremrses #2655313 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 1 ?l a_H recently certified not posted. 1 it 1 - No log posted last came Aug. z?l? 1 1 Policy needed for ErrEiloyee health [written] Procedures for responding to vomiting diarrhea! events 1 3 Using same one developed by Kimmarie RECORDS lPointsl IN our rum MIA cos COMMENTS Required records available; shellstock tags, parasite destructionJime As a Public Health Control, required legs 1 1 I I I I ITEM RECORD CHECKLIST Water quality and supply records, grease trap cleaning record, ansul system cleaning records and tags current, Fire or! manor :1 cuiroril 3: Employee training records it Temperature control records I NEED COOKING AND COOLING LOGS. RECEIVING LOGS Equipment monitoring and maintenance records it Calibration records it need log Sanitation records it Need log Required Logs; Time as a Public Health Control, Receiving Temperature, parasite destruction Pest control records it Need more information Variance request and approval, Time as a Public Health Control Procedure Inspection records la 9 incomino product. facility. production areal ITEMS OBSERVED IN: In Compliance Critical Items Observed (Primary, Primary Foundation) 1 OUT: Out of Compliance Non-Critical Items Observed (Primary Foundation, Core) 7 N10: Not Observed Total Non-Compliant Observations 8 Not Applicable COS: Corrected on Sight Score: 88 R: Repeat Violation OFFICIAL ORDER FOR Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order ofthe Board of Health, Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10] calendar days of receipt of this order. Additional Notes: The instructors were very knowledge tile and observed giving good instruction to students. Some items noted are people items that take time for novices to adopt proper practices. As this is a culinary program for students there is an anticpated learning curve but teachers have the skills to instill proper methods in students.0ver all cleanliness was good. 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Diagrams: Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 508-747?1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Southside Fare (South High Culinary School) Address: Long Pond Road Phone: 508-830-1036 Last Insp. Date: Purpose of Inspection: Reinspection Type of Establishment: Food Establishment Risk Category: High u?sefPerm'rt Numberfood Estilishment . MilkiElred Time tn: Time Out: 1:123 Date: #113019 Inspection by: Marcia Lee Signature: PIC Received by: chef Chris O'Connor Food borne Illness factors are Important practices or procedures identified as the most prevalent contributing factors of foodborne illness and/or injury. Public health interventions are control measures used to prevent such foodborne Illness andfor I?jUr?f Signature: Managers Email: Tvoes of Inspection: Routine, lie-Inspection, HACCP, Pre-Operation, Suspect Illness. Complaint, or Other Permit Holder: Corporate Email. Reinspection Date: 2/14/2019 SOURCE OF FOOD Point:- IN OUT COS COMMENTS Approved source for food, water,and ice; wholesome, nonadulterated 3 All foods must be stored in air tight, mvared, labeled recepticlas designed for the intended use Foods must be labeled to identify loco i: comma name date of opts-chenille oftrocn' [have precaution and a iraton FOOD PROTECTION Points OUT NJO MM COS COMM ENTS Potentially hazardous tood meets temperature reqmrements during storage, preparation, cooking, cooling, holding, display, service and transportation Adequate fac rlies to maintain product temperature, thermometers provided Thermometers provided and accurate, properly calibrated Potemially hazardous food property than-no Unwrapped or potentially hazardous food not reserved Food protected during storage, preparation, display, service transportation Food containers stored oft ?oor Washing fruits and vs etables Handling attend and ice minimized No bare hand contact with ready-to-eat foods, proper utensils used, or approved altemate method DroDerlv followed In use food dispensing utensils properly stored EMPLOYEE HEALTH Photogra Paints OUT him we cos COMMENTS Management awareness Proper use of reporting, proper restriction B: exclusmn for reportable diseases No from a as nose or mouth observed Proper eating, tasting, drinking Good hygienic practices, proper handwashing and glove changing observed, smoking restricted Proper hair and beard restraints are worn correctly, clean uniforms, kitchen whites. and aprons. Stuoents observed wearing JeWeIry including nose piercmgiewelry, need proper hair restraints thlrillhs EQUIPMENT l- DESIGN.CGN5TRUCTION li INSTALLATION Points OUT Info um cos COM Food-contact surfaces designed, constructed, maintained, installed, located Nonlood-contact surfaces designed, constructed. maintained, installed, located Dell-mulling facilities approved design, adequately month-clue, mnii-ilamnd, installed, locate-d 17 Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present Temperature and psi gauges are accurate need log, all items are run through dishwasher except extra large Tablewares and Equipment is pro-flushed. scraped, and soaked priorto cleaning Wash and rinse water is clean, and at proper temperature Sanitization rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature, chemical 20 concentration. exposure time for equipment and utensils PROTECTION FROM CONTAMINATION OUT NIO min cos COMMENTS Wiping cloths properly stored clean and dry or in a sanitizing solution Food-contact surfaces of utensils equipment clean Hood ?lters have accumulated dust Nonbod?oontoct surfaces in! utensils is clean cooking line rear accumulated dust observed on back of cooking equipment Proper equipmentlutansils storage, handling, to prevent contamination Single sehrioe articles are from an approved source, are stored, handled, dispensed, used and disposed of in a manner that prevents contamination No re?use of single service containers hr food or chemical storage photographs mus?R SUPPLY DISPOSAL Points OUT Ivjo ?In cos Water supply is from an approved source and water supply is suf?cient for the operations intended 3 COMMENTS Sewage disposal approved Proper disposal of wash: water in approved d?wuli?zdlh?b [in slog. 3 26 Court St. Plymouth, MA 02350 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM PLUMBING WT IN OUT No COS COMMENTS Location, installation, maintenance (ie dripping faucets, leaking pipes, improperly wasting pipes) 2 Plumbing installed preventing cross connection, back siphonage, back?ow 3 Adequme localities. ens-?y necessitate. etc-gnaw. 3 Toilet facilities: properly constructed, self closing doors, ?xtures in good repair, supplied with soap and towels in dispensers! hand-drying devices. cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from lead recess and etc area: 2 rmrapns FACILITY AND Point: IN OUT C05 Su?ioeint covered trash recepticles present in adequate number, leak proof, insect/rodent proof, emptied with adequate fre enc . clean 2 34 Outside premises are free from trash, etc free of harborages, breeding places for rodents, insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled . . .n 2 Doors, windows, and other openings are protected to eliminate entry by insects, rodents/pests NO evidence Of pests present 3 FLOORS, WALLS a CEILINGS Points IN our N/o NM cos Proper ?oor construction, proper ?oor covering installed, ?oors graded with drained as required, floor and wall juncture covered Floors in good reLair and clean Dustless cleaning methods used as needed 1 37 Walls, ceilings, attached equipment, properly constructed, good repair, clean. Wall a ceiling surfaces as required Dustless 1 cleaning methods used as needed Manuela lighting providocl tor suf?cient candle light Fixtures property shielded or use In! sheila-r pro-ed bulbs 1 39 Air quality and ventilation are adequate to remove excessive heat hr equipment and rooms and prevent contamination by dust, and/or o1har airborne substances 1 40 Locker rooms, employee changing areas, provided, located to prevent contamination of production areas, and used for storage at employee personal items properly equipped and properly ventilated Dressing moms are maintained in good physical repair. 1 41 In?ectrcides and are used and stored so as to prevent o! bed Items Detergents. and other cleaning supplies are used in a safe, elfective manner Hazardous materials are kept in their original containers and stored separate from raw materials 3 Premises maintained free of litter, unnecesary Items and articles, cleaning maintenance equipment propedy stored, 1 Separation of maintenance rooms and equipment, laundry facilities by partition. 1 So?e-d linens properly stored 1 Plimsrirlhs RESPONSIBLE PERSON IN CHARGE Points IN OUT ill/A COS COMMENTS Certi?ed Food Protection Manager SevSafe Susan Martin #14250078 exp 10/5/1021; Christopher O'Connor 3 3: #10847031 exp 3/19/19 PIC I5 knowledgeable and understands sanitary controls demonstrates competence 2 ITEM rim-mm HIGHLY SUSCEPTABLE POPULATIONS IPointsI IN our N10 cos 47 Pastuerized foods used; prohibited foods not offered ITEM Photographs [Pointsl Food additives approved and prop-tarry used I 3 I I I I ITEM Photographs EQUIPMENT AND UTENSILS Points IN OUT N/o cos COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food 2 Instruments and controls used for measuring, regulating, or recording temperature, pH, acidity, water activity, or other conditions are accurate and adacuatel maintained 1 1t em'rome ers, and er devices -r con ro aza us are accura and aaequarery maintained 1 ITEM rmsrapns LICENSURE IPuIntsI IN I OUT I cos COMMENTS 52 Firm is currently licensed by the regulatory authority haying premises Photographs CONFORMANCE WITH APPROVED PROCEDURES (INT 1 pt for all) Points IN OUT til/A CUS- 1 Barry Levy, #2683313 exp 12/6/2021 1 1 Corn limo-I: with mucosa 1 1 all recentty certified not posted. 1 I F-O-G- BOH R?a?on 1 No log posted last Cli'l'lrl! Aug. 20:3 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ham: policy pram-Policy needed for Employee health (written) Procedures for responding to vomiting cit: diarrhea] events Using same one developed by Kimmarie ITEM Photo-ranks RECORDS LPointsI COMMENTS Required records available; shellstocktags, parasite destruction,Time As a Public Health Control, required logs ITEM Fmravhs RECORD CHECKLIST Water quality and supply records, grease trap cleaning record, ansul system cleaning records and tags current, Fire extin uisharta 3 current Employee training records Temperature control records 1 NEED COOKING AND COOLING LOGS, RECEIVING LOGS Equipment monitoring and maintenance records Calibration records it need log Sanitation records Need log Required Logs; Time as a Public Health Control. Receiving Temperature. parasite destruction it Pest control records it Need more information Variance request and approval. Time as a Public Health Control Procedure Inspection records (a incoming product facility, production area) ITEMS OBSERVED IN: In Compliance Critical Items Observed (Primary, Primary Foundation) 0 OUT: Out of Compliance Non-Critical Items Observed (Primary Foundation, Core) 3 Mia: Not Observed Total Non-Compliant Observations 3 Not Applicable C05: Corrected on Sight Score: 95 R: Repeat Violation OFFICJAL ORDER FOR Based on an Inspection today, the Items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order ofthe Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health Your request for a Boa rd of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: The critical violations have ceased at the time of visit. Several items corrected. Will return to see hood cleaning and last few items corrected. The instructors were very knowledgable and observed giving good instruction to students. Some items noted are people items that take time for novices to adopt proper practices. As this is a culinary program for students there is an anticpated learning curve but teachers have the skills to instill proper methods in students.0ver all cleanliness was good 26 Court St. Plymouth, MA 02360 Tel: 508?747?1620, Extension 10118 5: agrams: Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St Plymouth, MA 02360 Tel: 508-747-1520, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Address: Long Pond Road Phone: 508-830-1036 Type of EstahIl-shment: Food Establish merrt NAME: Fare (South High Culinary Salient} Tune In: 12:00 Inspection by: Marti: tee Signature: Lest lnsp. Date: PIC Received by: Chef Chris O'Connor Purpose of Inspection: Routine Signature: Managers Email: coconnor@plymouth k12 ma.us Risk Category: High Permit Holder: License Pen-nit Nu mber:Focd Establishment . Milk ex - lred Carma Email: Time mu Foodoorne illness rIsic {actors are important practices or procedures Identified as the most prevalent contributing factors of foodborne illness and/or injury. Public health interventions are control measures used to prevent such foodborne illness andior iniury. Types Routine, Re-Inspection, HACCP, Pris-Operation. Suspect Illness, Complaint, or Other Reinspection Date: 2/14/2019 ITEM SOURCE or race Points OUT NIO A COS COMMENTS Approved source tor food_ water and um Minimum nonedulteratee 3 I All foods must be stored in a" tight. covered, labeled recepticles deslgned Ior the Intended use Foods must be labeled [0 niration 1 FOOD PROTECTION Points OUT rm. COS COMM ENTS Potentially hazardous food meets temperature requrrements durIng storage, preparauon, cooling, holding, msplay. sum so. one trans. nation Adequate facilities to maintaln product temperature, therrmmeters provided Them-roman. crowded and occur-rule. properly scammed Potentially hazardous food properly thawed Unwrapped or potentially hazardous food not reserved NNHUJLM Food protected during storage, preparation, display, service at transportation Food containers stored off floor Washing fruits and vegetables Handling of food and Ice mInImIzed No bare hand contact ready-to-eat toods, proper utens?s used, or approved alternate method properly followed In use food dispensing utensils properly stored EWLOYEE HEALTH OUT Nlo NIA COS Management awareness Proper use of reporting, proper restriction 5 exclusion for reportable diseases No discharge from eves nose. or mouth observed . Proper eating, tasting, drinking Good hygienic practices, proper and glove changing observed, smoking restricted Proper hair and heard restraints are worn correctly, clean uniforms. kitchen whites. and aprons. EQUIPMENT UTENSILS: DESIGN.CONSTRUCTION INSTALLATION OUT MIA COS COMMENTS Food-comm: surfaces designed, certain-rolled, marl-Minna, installed, Insured Nonfood-oontact surfaces designed, constructed, maintained, installed, located DIshwashIng appmved oasrgn, adequately constructed, maintained, Installed, located Proper chemical test kits, measuring devices for ph, thermal strips, and logs are present Temperature and psi gauges are accurate Tablewares and Equipment is pro-?ushed, scraped, and soaked prior to cleaning. Wash and rinse water is clean, and at proper temperature Sanitization rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature. chemical 2? omwro tum:- [or oquipmimt and mangle PROTECTION FROM CONTAMINATION Points OUT HID COS COMMENTS wiping cloths property stored clean and dry or In a sanitizing calm-on Food-Gem: surfaces of utensils a eqquI-neril clean Nonfood-oontact surfaces of utensils 8; equipment clean Proper equrpmentlutensns storage, handling, to prevent contamination NHN XXIX Single service articles are from an approved source. are stored, handled, dispensed. used and disposed of in a manner that ruvente contamination No re-use of single service containers for food or chemical storage ITEM WATER SUPPLY a. DEPOSAL OUT NIIO MIA COS Water supply is from an approved source and water supply is suf?cient forthe operations intended COMMENTS Sch-Iago disposal approved Proper dis-poem not waste water :n np-prpvod dl?pus??ncilmm {Io slap Fhamlrapns PLUMBING IDUTI we min cos COMMENTS Location, installation, maintenance (is dripping faucets, leaking pipes, improperly wasting pipes) 2 I I 26 Court St. Plymouth, MA 02360 Tel: 508?747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Plumbing installed preventing cross connection, back siphonage, back?ow 3 Adequate handwashing facilities, easily accessible, designed, installed 3 Toilet facilities: properly constructed, selt closing doors, ?xtures in good repair, supplied with soap and towels in dispensers! hand-drying devices, cleaned, covered sanitary dispoal recapticle, handwash signage present Toilet facilities have self-closing doors and doors do not open into areas where food is exposed to airborne contamination and are adequately separated from Food processing and storage areas 2 Photolraphs FACILITY AND GROUNDS Point:- IN OUT NM COS Suf?ceint covered trash recepticles present in adequate number, leak proof, insect/rodent proof, emptied with adequate [re uenc clean. 2 34 Outside premises are free from trash, etc free of harborages, breeding places for rodents, insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled . . 2 Doors, Windows, and other openings are protected to eliminate entry by insects, rodents/pests No evrdence Ot pests present 3 Phomirinhi FLOORS, WALLS a. CEILINGS Points IN OUT NIO COS COMMENTS Proper ?oor construction, proper ?oor covering installed, floors graded with drained as required, ?oor and wall juncture covered ?can In good repair and clean. Business clonnmq marmos- used as needed 1 3., Walls, attached equipment. properly constructed, good repair, clean Wall surfaces as reqUIred Dustless 1 It clean methods used as. needed. Adequate lighting provided [or sul?cienl candle light Fixtures property shielded or use Ofshatter prood bulbs 1 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, ortdl'orothor airborne substances 1 40 Locker rooms, employee changing areas, provided, located to prevent contamination of production areas, and used for storage of employee personal items properly equipped and properly ventilated Dressing rooms are maintained in good physical repair, 1 u: 41 Insecticides and rode notices are used and atom-n so as to prevent contamination o! loco item. Detergents, contracts and other cleaning supplies are used in a safe, e?ective manner Hazardous materials are kept in their original containers and stored separate from raw material: 3 Premises maintained tree orl'rtter, unnecesary items and articles, cleaning maintenance equipment property stored, 1 Sop-enliven of maintenance mama and cardamom. laundry laml?iua by partition 1 Suited linens progeny Blow-d 1 RESPONSIBLE PERSON IN CHARGE Points IN OUT COS COMMENTS Certi?ed Food Protection Manager SevSafe Susan Martin #14250073 exp 10/5/1021; Christopher O'Connor 3 t-i #10847031 exp 3/19/19 PIC is knowledgeable and understands sanitary controls demonstrates competence 2 1: ITEM Photo-rim HIGHLY SUSCEPTABLE POPULATIONS IPointsI Pastuerized foods used; prohibited foods not offered ITEM Photographs ADDITIVES IPointsI IN I curl we 1 cos as Food mail-mu approved and property used EQUIPMENT AND UTENSILS Points IN OUT uro Put/A cos COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough to avoid contamination of food 2 It Instruments and controls used for measuring, regulating, or recording temperature, pH, acidity, water activity, or other conditions are accurate and adequatel maintained 1 (W a 1 ITEM Photo-ram IPoinuI IN our NIH) cos COMMENTS Firm is currently licensed by the regulatory authority having jurisdiction premises CONFORMANCE WITH APPROVED PROCEURES (WT 1 pt for all) Points OUT C05 1 Barry Levv. #2685313 exp 12/6/2021 1 I ed proces/HACCP 1 .I 1 It 1 Ii F.0.G. LoLa] BOH R?lation 1 Ir Written health policy scent I I Procedures for responding to vomiting diarrheal evens 1 26 Court St. Plymouth, MA 02360 Tel: 508-747-1520, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM Phawarhs RECORDS [Painecos COMMENTS 54 Required records available; shellstock tags. parasite destruction.Time As a Public Health Control. required logs 1 a I ITEM RECORD CHECKLIST Water quality and supply records, grease trap cleaning record. ansul system cleaning records and tags current, Fire can in :l Current Employee training records :1 Temperature control records 1 NEED COOKING AND COOLING LOGS, RECEIVING LOGS EQUIDMI Ill-16 Calibration records it need log Sanl ation records It Need log Required Logs; Time as a Public Health Control. Receiving Temperature, parasite destruction Pest control records Need more information Variance request and approval, Time as a Public Health Control Procedure Inspection records (e incoming oroduct._f3c_llity. production area) ITEMS OBSERVED IN: In Compliance Critical Items Observed (Primary. Primary Foundation) 0 OUT: Out of Compliance Non-Critical Items Observed (Primary Foundation. Core) 0 WC: Not Observed Total Non-Compliant Observations 0 MIA: Not Applicable COS: Corrected on Sight Score: 100 R: Repeat Violation OF-FICIAL Dana: FOR CORRECHDN: Based on an Inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail. by a Plymouth Public Health Department inspector or an agent constitutes an order Of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. lf aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: The instructors were very knowledga ble and observed giving good instruction to students Some items noted are people items that take time for novices to adopt proper practices. As this is a culinary program for students there is an anticpated learning curve but teachers have the skills to instill proper methods in students.0ver all cleanliness was good. name nu, All items corrected for reinspection 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: Plymouth South Middle School Tim 11:30 ?me 00?: 1:15 DATE: 1/2411!) Foodborne illness risk factors are important practices or procedures Address: Long Pond Road Inspection by: Marcia lee identi?ed as the most prevalent contributing factors of foodborne Phone: 505224?7991 Signature: illness and/or injury. Public health interventions are Control measures last lnsp. Date: PIC Received by: David Maggiani used to prevent such foodborne illness and/or injury. Purpose of Inspection: Routine Signature: Types of Inspection: Routine, Re-lnspection, HACCP, Pre-Operation. Type of Est Food Establishment Managers Email: dmaggiani@plymouth.k12 rna us Suspect Illness, Complaint, or Other Risk Category: High Permit Holder: IReinspection Date: License/Permit Number:Food Establishment 826,Milk 821 Corporate Email: ON FILE 2/7/2019 ITEM SOURCE OF FOOD Points IN OUT NIO NIA COS COMMENTS 1 Approved source for food, water,and ice; wholesome, nonaidullerated 3 2 All feeds must be stored in air tight, covered, labeled reoepticles designed for the intended use Foods must be labeled to identify food by common name. date of production: date of freezing. thawing. preparation. and expiration 1 ITEM FOOD PROTECTION Points IN OUT NIO NIA COS COMMENTS 3 Potentially hazardous food meets temperature requirements during storage, preparation, cooking, cooling, noiding, display, service and transportation 3 4 Adequate faci ies to maintain producttemperature. thermometers provided 3 5 Thermometers mowed-o and accurate. modesty delimited 1 5 Potent hazardous food properly thawed 2 ,1 1 unwrapped or potentially hazardous food not reserved 2 3 Food protected during storage, preparation, display. service 8. transportation Food containers stored off floor Washing fruits and vegetables 2 No wash used for fresh fruit and vegetables. 9 Handling of food and ice minimized No bare hand contact with ready-to-eat foods. proper utensils used, or approved alternate meta-loci proper-y followup 3 a: 19 to uni: too-d dispensing utensils proporry attired 1 ITEM EMPLOYEE HEALTH Points IN DUT MO A COS COMMENTS 11 Management awareness; written health policy present Proper use of reporting, proper restriction 8t exclusion for reportable diseases Ne discharge Iron-I ayes. rinse, or mouth observed 3 it 12 Proper eating, tasting, drinking Good hygienic practices, proper handwashing and glove changing observed, smoking restricted 3 ii 13 Proper hair and beard restraints are worn correctly. clean uniforms. kitchen whites, and aprons. 1 1: ITEM EQUIPMENT 8- UTENSILS: DESIGN.CONSTRUCTION INSTALLATION Points IN OUT HID MIA COS COMMENTS 14 Food-contacl surfaces designed, constructed, maintained, Install-lid. located 2 15 Nonfood-oontaot surfaces designed. constructed. maintained. installed. located IBare wood storage shelves need sealing. All shelves must be made of 1 1 nonimpervious, easily cleanable. smooth surfaces. 16 Dishwashing facilities design, adequatew maintained. installed, located The dishwash machine needs to have the leaking pressure relief valve replaced. 2 2 Water is dripping on the floor. PSI gauge is not working. Proper chemical test kits, measuring devices for ph. thermal strips. and logs are present Temperature and psi gauges are accurate 1 I Tablewares and Equipment is FIFE-flushed, scraped, and soaked prior to cleaning 1 19 Wash and HMO water in clean, and it! proper Rinse water at 3 Bay sink is tested at 50F. For hookup of deemer system. May be 2 installed without a plumber. Sari Ization rinse (hot water - chemical) Proper sanitization of food contact surfaces through temperature, chemical concentration, 20 exposure time for equipment and utensils 3 I ITEM PROTECTION CONTAMINATION Points IN UUT him NIA COS COMMENTS 21 Wiping cloths properly stored clean and dry or in a sanitizing solution The dishwasher should not wipe clean wares with wiping cloth Observed 3 dishwasher wiping soiled hands on cloth and wiping wares 22 Food-contact audits-ac of utensils i5 clean 2 23 Nontaod-contact surfaces of utensils 5 equipment clean 1 1 24 Proper equipmentlutensils storage, handling, to prevent contamination 2 25 Single service articles are from an approved source, are stored, handled, dispensed, used and disposed of in a manner that prevents contamination 1 No re-use of single service containers for food or chemical storage 1 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM SUPPLY a. DISPOSAL POT IN OUT supply is an approved source and water supply is the operations intended 3 disposal approved Proper disposal of waste water in approved disposallacilities (is stop sinks) 3 PMWFIPVIS PLUMBING INT 2 3 Fiumbmg mutation: promnimg cross sack Ductile?: handwashing facilities, easily accessible, designed, installed Toilet facilities: properly constructed, self closing doors, ?xtures in good repair, supplied with soap and towels in dispensers! hand- devioes, cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors doors do not open into areas where food is exposed to airborne contamination and are adequately separated from food and areas OOVBTN trash reoepticles present In adequate number, leak Il'iSaCh'deB?t emptied adequate trequency, premises are free from trash, etc free of harborages, breeding places for rodents, insects, and other pests Outside (roads, yards, disposal systems) provide adequate drainage and do not constitute a source of contamination Controlled windows, are protected to entry by No pests present WALLS CEILINGS ?oor construction, proper ?oor covering installed, ?oors graded with drained as required, floor and wall juncture covered in ceilings, attached equipment, pmperty constructed, good repair, clean Well a ceiling surfaces as required Dustless lighting provided for suf?cient candle light Fixtures properly shielded or use of shatter prood bulbs quality and ventilation are adequate to remove excessive heat for equipment and rooms and prevent contamination by dust, rooms, employee changing areas, provided, heated to prevent contamination of production areas, and used for storage of items and ventilated rooms are maintained in are so as supplies are used in a safe, effective manner Hazardous materials are kept in their original containers and stored {rum raw material: maintained tree litter, unnecesary items and articles, cleaning maintenance eqUIpment properly stored, maintenance rooms and equipment. laundry facilities by partition Soiled linens properly stored PERSON IN CHARGE Food Protection Manager and understands controls demonstrates POPULATIONS I'oods used; prohibited foods not additiveszapproved and propeny used Points utensils and equipment are cleaned and sanitized at intervals that are products 2 and controls used for measuring, regulating, or recording temperature, water activity, or other conditions 1 Firm is currently licensed by the jurisdiction 26 Court St Plymouth, MA 02360 Tel: 503?747?1620, Extension 10113 COMMENTS andwash sinks in the dishwash room had a spray resting in the sink and a dunnage rack in front of the other Corrected walls of condensation freeze. shields need of mold COMMENTS COMMENTS Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM CONFORMANCE WITH APPROVE) PROCEDURES MT 1 pt for of) points l258695?gg?!l5f21 David Maggieanti choking 1 I 1 No records available Procedures for responding to vomiting 8.: diarrhea] events 1 1 Provide Written employee health policy. 1 ITEM Mir-Phi RECORDS [Points] 1 our] we I cos a COMMENTS 54 Reouired records available: shellstock tags. parasite destruction.Time As a Public Health Control. reduired legs ITEM RECORD CHECKLIST Water quality and supply records. grease trap cleaning record. ansul system cleaning records and tags current. Fire on: motion 5 cumin: I No grease trap records Employee Trauma-g rec-tilde Tempeiature control records 1: Equipment monitoring and maintenance records it Calibration records 1 I Sanitation records need thermal strip log and sanitizer legs. I Required Logs; Time as a Public Health Control. Receiving Temperature. parasite destruction 1 I Pest control records states pest control does not leave records. Variance request and approval. Time as a Public Health Control Procedure Inspection records (a . incoming product. facility. production area) It ITEMS OBSERVED IN: In Compliance Critical Items Observed (Primary. Primary Foundation) 0 OUT: Out of Compliance Non-Critical Items Observed (Primary Foundation. em) 4 Not Observed Total Non-Compliant Observations 4 Not Applicable COS: Corrected on Sight 95 R: Repeat Violation OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report. when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. lf aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Additional Notes: All wares will go through the dishwasher until such time as the warewash sink deemer system is properly installed. The spray above the handwash sink in the dishwasher makes use of the sink dif?cult. The spray could be removed as it is not in use according to the manager for ease of use for the handwash sink and to prevent spra'y hose from resting in the basin.Al temperatures were noted to be in proper range for hot holding at the line. Diagrams: Freezer has an issue with icing and condensation. This should be corrected. Cold units should be set to 36F to ensure recoup and maintenance of 41 or less for ambient airtemmperatures and freezers to keep foods frozen to the touch. All the signage was removed from the warewash area and needs to be replaced. It was taken to North by last manager. Was able to look at physical premises on 1/22/19 after visit to the high schoolfor approximately 45 minutes. Went over noted items with manager on this visit Time not included in this time in and out. 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name SI 3;qu (E 1.0mm: mint" I ?17197?? :Oood 8:30:33" 5 eoflns ection i?ROutine Address 11% {Scions (Leora? Risk Level Telephone' ?30% YR) C0 SCI [3 Retail Residential Kitchen Mobile Re?inspection Previous Inspection Date: owner? (fa ijmr?l?L HACCP YIN Pro-operation Caterer CI Suspect Illness Person In Charge (PIC) [thL-I i Time mm. (I gap in air-wait? fit. 54?" - In. HACCP Out Permit No CI Cl Temporary CI Bed Breakfast El General Complaint El Other Each violatia?h checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Violations marked may pose an imminent health hazard and require immediate corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1. PIC Assigned I Knowledgeable I Duties EMPLOYEE HEALTH 2. 3. Personnel RestrictedIEchuded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. 5. Statements [37. PROTECTION FROM CONTAMINATION Reporting of Diseases by Food Employee and PIC ReceivinglCondition Conformance with Approved Procedures/HACCP Plans B. [j 9. 10. ProperAdequate Handwashing Food Contact Surfaces Cleaning and Sanitizing 11. Good Hygienic Practices Violations Related to Good Retail Practices (Blue Items) Critical (C) violations marked must be corrected immediately or within 10 days as determined by the Board of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board of Health. 23. Management and Personnel 24. Food and Food Protection (FC-3II590.004I 25. Equipment and Utensils 26. Water, Plumbing and Waste 27. Physical Facility 28. Poisonous or Toxic Materials 29. Special Requirements (590.009) 30. Other Non-compliance with: Antl-Choklng 590.009 (E) Tobacco 590.009 (F) Allergen Awareness 590.009 (G) [3 12. Prevention of Contamination from Hands 13. Handwash Facilities PROTECTION FROM CHEMICALS 14. Approved Food or ColorAdditives D15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 1316. [:117. [118. Cooking Temperatures Rehea?ng Coonng D19. Hot and Cold Holding Ci 20. Time As a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) Ci 21. Food and Food Preparation for HSP CONSUMER ADVISORY El 22. Posting of Consumer Advisories Number of Violated Provisions Related .. To Foodborne Illnesses Interventions and Risk Factors (Red Items 1-22): Official Order for Correction: Based on an inspection today, the items checked indicate violations of 105 CMR 590.000IFederal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order. you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. DATE OF RE-INSPECTION: Inspector?sSignature: I): .CL I?rint: Kai/"cw x. his I?lC?s Signature: 1/us I?I?int: '1 Pilchli?l?p-H?cs 1.. if z'b' - FORM 734A AM CO CHARLESTOUVN MR 'r J. Violations Related to Foodborne Illness Interventions and Risk Factors (Red items 1-22) FOOD PROTECTION MANAGEMENT I Assignment of Responsibility? 590. 003(3) Demonstration of Knowledge* 2-103.? Person in charge - duties EMPLOYEE HEALTH 2 Responsibility of the person in charge to require reporting by food employees and applicants" Responsibility Of A Food Emplyee 0r An Applicant To Report To The Person In Charge" Reporting by Person in Charge" 3 Exclusions and Restrictions* Removal of Exclusions and Restrictions FOOD FROM APPROVED SOURCE 14 Food and Water From Regulated Sources Compliance with Food Law" 3-201.12 Food in a Hennetically Sealed Container? 3-201.13 Fluid Milk and Milk Products" $202.13 Shell Eggs* 3-202. 14 Eggs and Milk Products, Pasteurized* 3-202.16 Ice Made From Potable Drinking Water" 5-101.11 Drinking Water from an Approved System? sarcasm) Bottled Drinking Water? Water Meets Standards in 310 CMR 22.0* 3-201.14 Fish and Recreationally Caught Molluscan Shell?sh* 3-201.15 Molluscan Shell?sh from NSSP Listed Sources* Game and Wild Mushroom Approved by Regulatory Authority 3-202. 18 Shellstock Identi?cation Present* Wild Mushrooms* 3-201.17 Game Animals" 5 3-202.11 PI-IFs Received at Proper Temperatures* 3-202.15 Package Integrity" 3-101.11 Food Safe and Unadulterated" [6 Tagisecords: Shellstoclr 3-202.18 Shellstock Identi?cation" 3-203.12 Shellstock Identi?cation Maintained"r Tagsl?ecords: Fish Products 3402.11 Parasite Destruction?r 3402.12 I_-l_ecords. Creation and Retention" 590.0040) Labeling of lngredlents' Conformance with Approved Procedures Plans 3-502.11 Specialized Processing Methods?Ir 3602.12 Reduced oxygen pails-aging, criteria* 8403.12 Conformance with Approved Procedures" Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION Cross-contamination Raw Animal Foods Separated from Cooked and RTE Foods* Contamination n'om Raw ingredients 3-302.1 Raw Animal Foods Separated from Each Other* Contamination from the Environment Food Protection? 3-302.15 3-304.11 Washing Fruits and Vegetables" Food Contact with Equipment and Utensils?I r Contamination from the Consumer 3-306. Returned Food and Reservice of Food1 r Disposition ofAdulterated or Contaminated Food 3-701.? Discarding or Reconditioning Unsafe Food* 9 Food Contact Surfaces 4601.111 Manual Warewashing - Hot Water SanitizatiOn Temperatures? 4-501.112 Mechanical Warewashing - Hot Water Sanitization Temperatures" 4-501.ll4 Chemical Sanitization - temp, pH, concentration and hardness* sacrum Equipment Food Contact Surfaces and Utensils Clean? 4?602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils" 4-702.11 Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment* 4-703.? Methods of Sanitization - Hot Water and Chemical" Proper. Adequate Hendwashing 2-3OI.11 Clean Condition - Hands and Arms" 2-301.12 Cleaning Procedure" 2-301.l4 When to Wash" 11 Good Hygienic Practlces 2401.11 Eating, Drinking or Using Tobacco" 2401.12 Discharges fr0m the Eyes, Nose and Mouth?Ir 3-301.12 Preventing Contamination When Tasting" 12 Prevention of Contamlnatlon from Hands Preventing Contamination from Employees* Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities" 5-204.11 Location and Placement* 5-205.11 Accessibility. Operation and Maintainance Supplied with Soap and Hand Drying Devices 6-301.11 Handwashing Cleanser, Availability 6-301.12 Hand Drying Provision THE COMMONWEALTH OF MASSACHUSETTS TOWN CITY OF 10) (L7H (. EstabliShment JW?x?l #0 a of; I Date ?Eda -- Item ?em Reference Red ltem PLEASE PRINT CLEARLY Ven?ed NO. I .- NED-EL: 1 la: LC easing-:7 . - J'r?J?Cvc. ?1,43 frIt?; :gr'l I law-Cir? {2:170 reL011 LL43 ?lth?- r-s, 19w 4" .7'1 calf-LII? 53:4 v/ I Biscussion With Person in Charge: Corrective Action Required: CI No Yes CI Voluntary Compliance [1 El Re-inspection Scheduled El Embargo El CI Voluntary Disposal CI Employee Restriction! Exclusion Emergency Suspension Emergency Closure Olher: Violations Related to F0 Factors {Realises 1-22) (Cont) odoorne Illness Interventions and Risk PROTECTION FROM CHEMICALS 3-5011411') 3601.15 Pili-?s Received in Temperatures According to Law Cooled to 41? 745?}? Within 4 Hours. Cooling Methods for 14 3402.12 Food or Color Additives Additives" 3-36.32. 14' Protection from Unapproved Additives" 115 Poisonous or Toxic Substances 16 7-101.? Identifying Information Original Containers" 7-1011 1 Common Name Working Containers? 19 590.004tr) PHF Hot and Cold Holding Cold PHFS Maintained at or below 41?l45? Hot PHFs Maintained at or above 3-50 Roasts Held at or above Time as a Public Health Control 7-20 1 .11 7-2011 I Separation Storage? Restriction Presence and Use" 7-202.12 7-2011 1 Conditions of Use" Toxic Containers Prohibitions? 75204.1 1 7-204.12 Sanitizers, Criteria Chemicals" Chemicals for Washing Produce, Criteria" 3-501.19 Time as a Public Health Controi' Variance Requirement REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 7-204. I 4 Drying Agents, Criteria? 21 Unpasteurized Pro-packaged Juices and Beverages with Warning Labels? 7-205. [1 incidental Food Contact, Lubricants? 7-206.1 1 Restricted Use Pesticides, Criteriat 7-206. I 2 Rodent Bait Stations" 75206.13 Tracking Powders, Pest Control and Monitoring? TIMEITEMPERATURE CONTROLS Proper Cooking Temperatures for PHFs 34101.1 3-301.1 Use of Pasteurized Eggs" Raw Seed Sprouts Not Served. ?i Raw or Partially Cooked Animal Food and Tsaruw) Unopened Fnotl Package Not Re?served. CONSUMER ADVISORY 3-401.1 lA(1)(2) Eggs- [5 Sec. Eggs- immediate Service [45?F155ec? 22 3-603.[ Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or Not Otherwise Processed to Eliminate Pathogens-t E?odivv Ill/200! l'nsteuriacd Eggs Substitute for Raw Shell Eggs? Comminuted Fish, Meats 61. Game Animals - [5 sec. 3-401. 1 Pork and BeefRoast - [21 min? 3401.1 Ratites, injected Meats 15 see. a Poultry, Wild Game. Stuffed Pl-lFs, Stuf?ng Containing Fish, Meal, Poultry or Ralites-165?F 15 sec. 31-401.! Whole-muscle. intact 3401.12 Raw Animal Funds Cooked in a Microwave SPECIAL REQUIREMENTS J) Violations of Section in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 Special Requirements. All Other - [5 sec. 117 Reheating for Hot Holding 3-4011 PHFs 15 sec. Microwave- 165? 2 Minute Standing Time" Commercially Processed RTE Food - RELATED TO GOOD RETAIL (Blue items 23-311) Critical mnt? "mt?critical 1-1 ?lotions. which do not relate to the hormonal illness inm?vuntitms and ?have. can be from! tn the following avertiens of the i'imri If 'rm'c and i 1'15 0de 5 90. 000. Item Good Retail Practices F0 530. 000 23. Management and Personnel FC - 2 -003 3403.1 1(13) Remaining Unsliced Portions ol'itcci' Roasts? 24. Food and Food Protection FC 3 .004 25. Equupment and Utensils FC 4 .005 Proper Cooling of PHFs 26. Water. Plumbing and Waste FC - 5 .005 Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Cooling Cooked PHFs from to Within 2 Hours and From to Within 4 Hours. 28. 27 Physical Facility FC - 6 .007 Poisonous or Toxic Materials FC 7 .008 29. Special Requirements .009 30. Other 3-501 Cooling Pill-'3 Made From Ambient Temperature ingredients to 4 Within 4 Hours? Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM FACILITY NAME: South Elementary School In: 11:15 [Out: [5.17.19 Foodtrorne illness rislt factors are Important practices or procedures identified as the most prevalent contributing factors of foodborne Address: 117 Long Pond Rd :lnspection by: Marcia Lee Phone: 508.830. Signature: illness and/or injury. Public health interventions are control measures Last lrisp. Date: 12.12.17 Received by: Cheryl Renguist used to prevent such foodborne illness andfor injury. Purpose of inspection: routine Signature: Types of Inspection: Routine, Re~ nspection, HACCP, Pre?Operation, Type of Establishment: school Email: Suspect Illness, {omplaint. or Other Liconse?arrnit Nun-1hr: Business Email: 951, food,952 milk SOURCE OF FOOD Points IN OUT NED NIA E05 ITE Code COMMENTS Approved source tor bod water.? ice; meets-ad at prop? lul'rtp?la'mlull. minor-rte. 1 nonedultereted. in good condition. records available. ga?zoi .11. $202.11. $202.15 3 590 003W lien-u must be property data marking A disposition: date propane. data frozen. date 2 . . . IW -ioI1 9501.17 2 .c 590 001 using color coded dot system forfood dating. FOOD PROTECTION Points IN OUT Nit} NIA ITE Code COMMENTS Potentially hanrdous iood meets temperature requirements during storage. preparation. 3 3 temperatures on wen]:- on .--.-L. or qumu' to m. mL. glam; ice system is ?Ensign?. cooking. reheating. holding. display. servrce. and transportation 11' ?3 590 003 manager is rotating food in and out ofthe coolers between lunches to keep temperatures at 501.14. ?3?406 11. 53-501 16. ?3~501 19 urns-:- levels 4 Adequate to maintain product temperature. thermometers provroed 1 4 59:) can 5 Thermometers are present. conspicuously placed. accurate, calibrated, present 1 5 590 003 6 Potentially hazardous food properly thawed 2 6 1 Proper disposition of returned. previously served. reconditioned. and unsafe food ?3?306 14 2 7 590 003 3 Food protected during storage. preparation. display. senrice transportation Food 3 containers stared off?oor Washing fruits and vegetables ?3-302 11. ?3?304.11. 304 15M), 534306.131!? 3 590 003 p'pf,c No bare hand contact with ready-to-eat foods. proper utensils used. or approved altsmate 9 method bib-tied ?301 11(0X1H2)Good hygienic practices. proper handwashing and glove changing observed 52-30111. ?2?301 12. ?2-301 14 3 . 530 003:0) In use food dispensing utensils properly stored 1 10 590 003 ITE I EWLOYEE HEALTH Points IN OUT HID MIA ITE Code DOM MENTS Mano-gm! mo; Proper use at rep-oiling. pro-par a exclusion [or 11 reportable diseases ?2?201 11. ?2-201 12. ?2?201 .13 No discharge from eyes. nose. or 530 002 mouth observed. 3 :1 Proper eating. tasting. drinking Smoking restricted ?2?401 11. 53-30112 Point IN OUT NID HEM Code COMMENTS Food-contact suitaces desrgned. constructed. maintained. installed. located 2 14 530.007 Noniood?contacl surfaces designed. constructed, maintained. installed, located 1 it 15 530 007 15 Disnwasning facilities approved design. adequately constructed. maintained, installed. 15 located 2 2 590.004 aunaes are not providing accurate reading. wash iemoerature is in the 170's while final rinse 160's Pmper chemical test kitS. measuring devices for ph. thermal sin'pS. and logs are preseni 17 missing thermal strips or maximum holding thermometer to verify plate temp guages indicate 1150 Temperature and psi gauges are accurate 4-501 113 1 1 59? 004 rinse not 180 Tablewares and Equipmenl is pro-?ushed, scraped. and soaked prior to cleaning. 13 1 1 590 004 Wash and rinse water is clean. and at proper temperature 2 It 19 550 005 Sanitization rinse (not water- chemical) Proper sanitization of food contact surfaces through temperature. chemical concentration. exposure time for equipment and utensils 54- ?0 3 20 mm: 'iiv thermal sun: 160 at oat-J even with improper guage reading PROTECTION FROM CONTAMNATION Poln? IN OUT NIA COS ITE Code - Wiping cloths properly stored clean and dry or in a sanitizing solution 21 590 003 2 1 590.004 Food-contact surfaces of utensils 5. equipment clean 54-602 11 2 2 22 590 004 Hood [onscreens accumulated dust. need cleaning Nonfood-oontact surfaces of utensils 8. equipment clean 1 23 590 004 Proper equiprnentlutsnsils storage. handling, to prevent contamination 1 24 590 004 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM 11's PROTECTION FROM CONTAMNATION Points IN OUT NIO NIA COS- lTE?Code COMMENTS Single some: articles are from an approved source. are stored. mulled. dispensed mind. 25 550 004 and oiln a marina! Inn: craves-ltd onnlarninal-nn 1 I No re?use of single service containers for food or chemical storage 1 25 590 004 WATER SUPPLY a DISPOSAL Paints IN our intro MIA cos it I Code COMMENTS and supply us irom an approved source and water supply I5 su?icI-ent for the operations Sewage dIsposaI approved Proper disposal or waste water in approved disposaliacilities lie 23 550 DDS slop sinks} 3 3? WT IN OUT NIO NIA COS Code Location, installation, maintenance (is dripping faucets. leaking pipes. improperly wasting pi: 1 29 590 005 COMMENTS Plumbing installed preventing cross connection, back siphonage. back?ow 2 30 530 005 Adequate handwasning facilities. easily accessible, dasmnad. Installed ?5-202 12 31 590 005 . 3 Tania! facilrlioe' properly constructed. self closing doors. ?xtures In good Ienow. supplied 32 with soap and towels dispensers! hand-drying devices, cleaned, coveted sanitary depoel hand-unrest: signage men-on! Tells! feral-hoe have coil-cloning doors and dome do 590 006 not upon me areas more icon :5 caused to rum-cine and are adequately 530 005 separatcd tron] loo-d prose-sung and storage areas 2 Phatnuaphs FACILITY AND enouuos PointCode 33 Su?iceint covered trash recepticles present in adequate number, leak proof, Insectirodent 33 590 005 proof. emptied with adequate frequency, clean. 2 34 Out undo diarrhoea- ore iron l'mm trash. etc, ire-o oi narbnragos, brooding places moms, 34 Insects and other peat: Outs Idd area-a (rod-d5, yams, died-deal systems]: pro-adult adequate 590 006 drainage and do not constitute a source of coma mmnhon Contro?vod immoral-on 2 I Doors, windows, and other openings are protected to eliminate entry by insects, 35 590 006 rodentsl-estsr No evidence of -ests present 3 FLOORS, WALLS 8: CEILINGS Points IN OUT MID NIA COS Code COMMENTS 35 1: Proper ?oor construction, proper ?oor covering installed. ?oors graded with drained as 35 required. ?oor and wall juncture covered Floors in good repair and clean Dustless cleaning 590 m6 teed as. needed 1 ?oor under dishwasher cracked, lifting, Walls, ceilings, attached equipment, properly constructed. good repair. clean Wall 8. 37 ceiling surfaces as required Dustiess cleaning methods used as needed 1 37 590.006 33 Adequate lightIng proVIded tor sufliCIent candle light Fixtures properly shielded or use of 33 590 006 shatter rood bulbs 1 33 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms 39 590 004 and revent contamination dusL andfor other airborne substancg 1 The hood and ansul system are not aged 40 40 Locker rooms, employee changing areas, provided, located to prevent contamination of production areas. and used for storage of employee personal items properly equipped and 590 004 properly ventilated Dressing rooms are maintained in good physical repair. 1 1 41 41 Insecticides and rodenticidea are used and stored so as to prevent contamination of food items. Detergents, sanitizers and other cleaning supplies are used in a safe, effective 590 007 manner Hazardous materials are kept in their original containers and stored separate from raw materials. 537-202 12, ?7?203.11, ?7-101 111 ?7?201 11 3 1 42 Premises maintained free oflitter. unnecesary items and articles. cleaning maintenance 42 - 590 0'06 stored. 1 43 Separation of maintenance rooms and equipment, laundry facilities by partition 1 43 590 mm 4.4 Sound linens properly stored 1 44 590 004 IRESPONSIBLE PERSON IN CHARGE Point IN OUT NIO NIA ICOS Code COMMENTS Certi?ed Food PfOieCtlDi'l Manager present, knowledgeable, understands sanitary controls, demonstrates 46 590?qu Cheryl Lanquist exp 5.17 22m, La urae Murphy #15505904, exp. 8 24225147282 knowledge, performs duties. 52403.11 3 590.002 A 26 Court St. Plymouth, MA 02350 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL INSPECTION FORM ITEM Will's HIGHLY SUSCEPTABLE POPULATIONS Points IN DUT NIA (Gil ITE Code 47 Fastuarized bode used; prohibited foods not offered ?3?801 11 47 3 590 003 ITE Plump-apt: FOODICOLOR ADDITIVES Points IN OUT MID NM 005 ITE Code 43 Food additiveszapproved and properly used ?3~202 12 2 43 590 003 ITE EQUIPIEHT AND UTENSILS Points IN OUT HID COS ITE Code COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are frequent enough 49 590 004 to avoid contamination af?xed piecing. 64402.11 1 1 5? pf'c 'nlw?n'lt and carried: used for mr-h? regulating. or recording temperature. pH, acrdIty. water 50 activity. or other conditions are accull?n and adequately maintained and calibrated 590 004 1 It 51 Molluskan Shellfish Tanks maintained. tested. and logs kept 1 51 590 004 ITEM Photon-anti: HEALTH PROCEDURES Points IN OUT NIO NIA EOSI ITE Code COMMENTS 52 pt mm for responding to vomiting diarrhea! events. 1 52 590 002 CONSUMER ADVISORY POSTED Points IN OUT N/o NIA cos ITEM Code COMMENTS Consumer Advisory Posted. {53-603 II 1 53 590 003 Poin? IN OUT NIO NIA COS ITEM Codi: Required records available; shellstock tags. paraslte destructionJime As a PubIIc Health 54 590 on: Control re-uired lo-s. ?3-203.12 ?3?402 11 3?4-0212. l513?20118 3 I: with signing-glued $3-302.l4 2 a 5-5 590 [108(k) CONFORMANCE WITH APPROVED PROCEDURES Paton IN OUT N10 NIA ITEM Code COMMENTS hilt-men Certificate Ii 5943 011m Che-ryJ laneuist cap 3' 21.2.3. #2434122 Anti-Chotin It 590 011 MI in 6. local BOH Ft 3 local records are not ca ital house the plumber clean the grease trap advised about fog Firm is currently licensed by the regulatory authority having jurisdiction it local RECORD CHECKLIST ITEM Code COMMENTS Water quality and supply records. grease trap cleaning record. ansul system cleaning records and tags current. Fire extinqujsher tags current It Employee training records Temperature control records 1: Equipment monitoring and maintenance records It Calibration records 3 Sanitation records It RequIred Logs; Time as a Public Health Control, Receiving Temperature. parasite 590 005 destruction It Pest control recolds Variance request and approval Time as a Public Health Control Procedure 530 003m) Inspection records (a . incoming product. facility. production areal ITEMS OBSERVED In Compliance In Red Risk Factors Observed (Priority) pls. Deducted 0 OUT: Out of Compliance In Blue Good Reta_il Practices 0bse_rved (Priority Foundation. Core) pts. Deducted 7 Not observed Total Non-Compliant Observations total points deducted 7 Not Applicable SCORE: 93 cos: Corrected on Sight 'iriotatlo l'lil cited must be corrected within the tin-re frames in section $405.11 or in dates otherwise written in the report Repeat Violation 25 Court St. Plymouth, MA 02350 Tel: 508-747?1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM Temperatures Taken: OFFICIAL ORDER FDR Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation 2013 Federal Food and Drug Administration (FDA) Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Fallure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10} calendar days of receipt of this order. hot holder set at 180. top shelf 180, second 15?, third 14? lower 16? 26 Court St. Plymouth, MA 02350 Tel: 503?747-1520, Extension 10113 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF PLYMOUTH Massachusetts Department of Public Health Division of Food and Drugs FOOD ESTABLISHMENT INSPECTION REPORT Name i Date Tips-of Operationts) action I Food Service ?Routine Address i I Retail Re-ins action (it? n. arr-cm LA Jar-r3 Is Level Residential Kitchen Previous Inspection Telephone Temporary Pre-Operation Time El Caterer Suspect Illness Person in Charge PICregoI In: El HACCP Bed 8. Breakfast General Complaint Inspector 1&er Out: Permit No. Other Each violatiori? checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Antl-Choklng 590.0095) [3 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco action as determined by the Board of Health. merge" Awareness 590-009 (3) EIEI FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands 1. FIG Assi ned Knowled eab [113. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E114. Approved Food or ColorAdditives D15. Toxic Chemicals TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) 2. Reporting of Diseases by Food Employee and PIC 3. Personnel with Infections RestrictedlExcluded FOOD FROM APPROVED SOURCE 4. Food and Water from Approved Source 5. ReceivinglCondition 15. Cooking Temperatures 6. TagisecordslAccuracy oi Ingredient Statements CI 17- Reheating CI 7. Conformance with Approved ProcedureslHACCP Plans Cooling PROTECTION FROM CONTAMINATION CI 19. Hot and Cold Holding El 8. 20- Time As a Public Health Control 9. Foo (?so 10. ProperAdequate Handwashing CONSUMER ADVISORY 11' Hygienic Practices 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) critical (C) violations marked must be corrected T0 Foodborne Illnesses Interventions a immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22); of Health. Non-critical (N) violations must be corrected . . . Official Order for Correction: Based on an inspection Immediately or Within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR 590.000/Federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 24 Food and Food Protection 004) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of 25' EqUIpment and Utensds the food establishment permit and cessation of food 26' Water, Plumbing and Waste establishment Operations. If aggrieved by this order, you 27' Physical Facility CFC-GII590-007) have a right to a hearing. Your request must be in writing 23- POISONOUS 0T TOXIC Materials and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF 23. Management and Personnel Inspector?s Signature: ?1 57:4?ka print: {if?"i Ki i'i gi- Signature: .- I Print: i Page?0 Pages I i, KKI FORM 734A AM SULKIN CD Esmwn? Violations Related to Foodbome Illness interventions and Risk Factors (Red items 1-22) FOOD PROTECTION MANAGEMENT ssonosm Assignment of Responsibility? 590003113) Demonstration of Knowledge? 2-103.? Person in charge - duties EMPLOYEE HEALTH Responsibility of the person in charge to require reporting by food employees and applicants" Responsibility Of A Food Emplyee Or An Applicant To Report To The Person In Charge" Reporting by Person in Charge* 3 Exclusions and Restrictions* Removal of Exclusions and Restrictions FOOD FROM APPROVED SOUREE 4 Food and Water From Regulated Sources Compliance with Food Law" 3-201.12 Food in a Hermetically Sealed Container* 3-201.l3 Fluid Milk and Milk Products? 3-202. 13 Shell Eggs" 3-202. 14 Eggs and Milk Products. Pasteurized* 3-202.16 Ice Made From Potable Drinking Water" 5-101.11 Drinking Water from an Approved System" ssoeenm Bottled Drinking Water* Water Meets Standards in 310 CMR 220* Shellfish and Fish from an Approved Source 3-201.l4 Fish and Recreationally Caught Molluscan Shell?sh* 3-201.15 Molluscan Shell?sh from NSSP Listed Sources* Game and Mid Mushrooms Approved by RegulatoryAuthority 3-202.l8 Shellstock Identi?cation Present? Wild Mushrooms* 3-201.17 Game Amm' als* 15 ReceivingICondition 3-202.1 1 PI-IFs Received at Proper Temperatures* 3-202. 15 Package Integ-ity??r 3-101.11 Food Safe and Unadulterated* I6 Tagsl?ecortls: Sheilstock 3-202. 18 Shellstock Identi?cation? 3-203.12 Shellstock Identi?cation Maintained* Tagslkocords: Fish Products 34102.11 Parasite Destruction? 3402. I 2 Records. Creation and Retention* 590.0040) Labeling of I_n!redlents* Conformance with Approved Procedures MACCP Plans 3-502.11 Specialized Processing Methods* 3502.12 Reduced oxygen packaging, criteria? 8-103.12 Conformance with Approved Procedures* Denotes critial item in the Federal 1999 Food Code or 105 CMR 590.000. PROTECTION FROM CONTAMINATION Cross-contamination Raw Animal Foods Separated from Cooked and RTE Foods" Contamination from Raw ingredients 3-3 02.1 Raw Animal Foods Separated from Each Other?" Contamination from the Environment 3.302.] Food Protection"r 3-302.15 WashiniFruits and Vegetables' 3-304.11 Food Contact with Equipment and Utensils? Contamination from the Consumer 3.305. Returned Food and Reservice of Food" Disposition ofAduitaratad or Contaminated Food 3-701.11 Discarding or Reconditioning Unsafe Food* Food Contact Surfaces 4601.111 4-501.112 Manual Warewashing - Hot Water Sanitization Temperatures* Mechanical Warewashing - Hot Water Sanitization Temperatures* 4-501.114 Chemical Sanitization - temp., pH, concentration and hardness* Equipment Food Contact Surfaces and Utensils Clean* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* 4-702.ll Frequency of Sanitation of Utensils and Food Contact Surfaces of Equipment1 r 4-703.11 Methods of Sanitization - Hot Water and Chemical* Proper, Adequate 2-301.11 Clean Condition - Hands and Anns* 2-301.12 Cleaning Procedure? 2-301.l4 When to Wash* 11 Good Hygienic Practices [12 2-401.? Eating, Drinking or Using Tobacco* 2401.12 Discharges from the Eyes, Nose and Mouth? 3-301.12 Preventing Contamination When Tasting Prevention of contamination from Hands Preventing Contamination from Employees* 13 Handwash Facilities Conveniently Located and Accessible 5-203.11 Numbers and Capacities? 5-201? 1 Location and Placement"r 5-205 .11 Accessibility, Operation and Maintainance Supplied with Soap and Hand Drying Devices 6-301.? Handwashing Cleanser, Availability 6601.12 Hand Drying Provision TOWN OR CITY OF [Amt Wm THE COMMONWEALTH OF MASSACHUSETTS (Pi 9mm ?9?on Establishment Name: Date: {8.}.1Vh7 Page: Item Code 0-Crlti?llt?m Dalia No. Reference R-Rodltern Veri?ed <24 #51122?qu (M L3 <30 L3 l? ?5?33: 31% Sin-~9~ ROFL Eng/ Riwdzw 90% mm who Sim/3} A lam/120', A?#:0101529 or p?awl? Cabal Eta/W Discussion With Person in Charge: Corrective Action Required: 0 No Yes :1 Voluntary Compliance CI Employee Restriction! Exclusion El Re-inspection Scheduled CI Emergency Suspension ID Embargo 0 Emergency Closure 0 Voluntary Disposal Cl Other: Form 734 AM. Sulkin Boston, MA Violations Related to Foodbome illness Interventions and Risk Factors (Red items 1-22) (Cont) PROTECTION FROM 14 3-302.? 15 - 11 1-201.? 1-202.? 1. 7-203.n - .i - 12 1-204.? . 1- 7-206. 12 CONTROLS or Additives or oxle Substances Information Containers? Name of Criteria ChemicalsF Chemicals Criteria? Food Contact, Use Criteria" Powders, Pest Control and 16 Proper Cooking Temperatures for PHFs Eggs- 15 Sec. Eggs- [mediate Service 145?Fl55ec? 3-40 I . li(A)(2) Comminuted Fish, Meats 0: Game Animals - l5 sec. 3-401. Pork and Beef Roast - 121 min'II Ratites, Injected Meats 15 see. i Poultry, Wild Game, Stuffed PHFs. Stuf?ng Containing Fish, Meat. Poultry or Ratites-165?F 15 sec. 3401.1 Whole-muscle, intact Beef Steaks l45?F 3401.12 Raw Animal Foods Cooked in a Microwave All Other PHFs l45?F 15 sec. I17 3-40 I .1 nan Reheatlng for Hot Holding 3-403. I PHFs 15 sec. 3403.110? Microwave- 2 Minute Standing Time" 3403.1 Commercially Processed RTE Food - Remaining Unsliced Portions of Beef Roasts? [18 Proper Cooling of PHFs Cooling Cooked PHFs from l40?F to Within 2 Hours and From to Within 4 Hours. 3-50l . I 4(3) Cooling PHFs Made From Ambient Temperature ingredients to 4i?Fl45?F Within 4 Hours? Denotes critical item in the federal I999 Food Code or 105 CMR 590.000. ;-?Pl-lFs Received jit'Temperamres According to Law Cooled to Within 4 Hours. 3601.15 Cooling Methods for Pl-[Tis l9 PI-IF Hot and Cold Holding 590.0040) Cold Maintained at or below 4l?l45? Hot PHFs Maintained at or above Roasts Held at or above r20 Time as a Public Health Control Time as a Public Health Control? Variance Requirement REQUIREMENTS FOR HIGHLY POPULATIONS (use) 21 Unpasteurized Pro-packaged Juice: and Elevatages with Warning Labels? 3-801J Use of Pasteur-ind Eggs' 3-8011 Raw or Partially Cooked Animal Feed and Raw Seed Sprouts Not Served. $301.] Unopened Food Package Not lie-served. CONSU MER ADVISORY 22 3-603.? Consumer Advisory Posted for Consumption of Animal Foods That are Raw, Undercooked or Not Otherwise Processed to Eliminate Pathogens.? 3-3011] Pasteurized Eggs Substitute for Raw Shell Eggs? SPECIAL REQUIREMENTS Violations of Section in catering, mobile food, temporary and residential kitchen operations should be debited under the appropriate sections above if related to foodbome illness interventions and risk factors. Other 590.009 violations relating to good retail practices should be debited under #29 - Special Requirements. VIOLA WNS RELATED TO GOOD RETAIL PRACTICES (Blue Items 23-30) Critical and non-critical violations. which do not relate to the foodborne illness interventions and risk factors listed above. can be found in the follow 5 90. 000. item 23. 24. Food and 25. 26. Water 20. Retell Practices lug sections of the Food Code and MS CMR FC and Food Protection - FC-S 590.000 and Waste or Toxic - Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM NAME: West Elementary In: 12:25 lam: I IS.23.19 Foodbornc illness risk factors are important practices or procedurg Address: 70 Rd Inspection by: Marcia Lee identified as the most prevalent contributing factors of foodborne Phone: SDB Signatu re: illness and/or injury. Public health interventions are control measures Last lnsp. Date: unknown Received by: michele Flieget used to prevent such foodborne illness andfor injury. Purpose 'routlne Signature: fur" Types Routine, lie?Inspection, HACCP, Pre-Operation, Type of Establishment: elementary school Email: rnflie el i-rliaurl-Ifumlm Suspect Illness. Complaint. or Other Humfrennil Number: 103?. 1086 Business Email: SOURCE OF FOOD Points IN OUT NIA COS ITE Code COMM ENTS Approved source for food. water.and Ice; received at proper temperatures. Wholesome. 1 nonadultaratad. In good condition, records available ?3-201 11, ?3?202.11, ?3-202 15 3 590 003M) items must be properly date marking adisposilion: date prepared, date frozen. date thawed. 2 prupn-y cit-2i ?rst: by common name not "aw: common name an: aiqoiration date 53-501 19. ?3501 17 2 590 007 from master carton ITEM FOOD PROTECTION Points IN OUT NIO NIA (205 ITE Code COMMENTS 3 Potentially hazardous load meets temperature reqUIremen?ls dunng storage. preparation. 3 cooking. cooling. reheating. holding. display. service. and transportation 913-401 11. 550 003 19 3 3 ideas were noted out of :Ir'rtpi"aiare 4 Pf Adequate facilities to maintain product temperature. thermometers provided 2 2 4 sec 004 mealtime": control units to mainain Toma: No c0 d 5 on: present. conepmousty pieced. ammo. calibrated. present 1 5 590 003 Pf Potentially hazardous food 2 5 7 Proper disposition of returned. previously served. reconditioned. and unsafe food ?$306 14. 2 7 590 003 Food protected during storage. preparation, display, service transportation Food 5 containers stored floor Washing fruits and vegetables ?3-302 11. ?3-304.11. 304 15lA). ?3-306 3 590 003 9 No onto hand contact With ready-tweet foods. proper climate uood. or approved alternate 9 method property hemmed. ?3~361 ?301 hygienic practices, proper handwashing and glove changing observed ?2-301 11, ?2-301 12. ?2?301 14 3 590 003(0) In use food dispensmg utensns properly stored 1 10 590 003 ITEM EMPLOYEE HEN-TH Points IN OUT NIO NIA COS ITE Code 11 Management awareness; Proper use of reporting. proper restriction exclusion for 11 reportable diseases. 52-201 11. 52-201 .12. ?2?201 13 No discharge from eyes. nose. or 590 002 mouth obeerved. {52401.12 3 ii 12 p'c Propereating.tastirig. drinking Smoking restricted ?2?4o1 11, 53-301 racer mm a a tee rain :1 are worn coiruci y_ l.'al'l uni arms. is on res. ii 13 aprons. proper glove use 1 590 002 Marlyn: EQUIPMENT 8- UTENSILS: DESIGN.CONSTRUCTION 5 INSTALLATION Polnt Il'il OUT NID NIA COS ITE Code COMMENTS Food-contact surfaces designed. constructed. maintained. installed. located 2 14 590 007 Nonfood?oontact surlaces designed. constructed. maintained. installed. located 1 15 590 007 Dishwashing facilities approved design. adequately constructed. maintained. installed, 15 located 2 sec 004 Proper chemical test kits. measuring devices for ph. thermal strips. and logs are present 17 590 004 Temperature and psi gauges are accurate 4-501 113 1 No way to veritv water temperatures Without thermal ?nes or maximum holding thermometer wher- Tablewares and EqUIpmerit is pro-?ushed. scraped. and soaked prior to cleaning 13 1 590.004 Wash and rinse water is clean. and at proper temperature 2 15 590 005 Sanitization n'nse (hot water - chemical) Proper sanitization of food contact surfaces through temperature. chemical concentration. exposure time for equipment and utensils 54-501 111- 115, 54-703 11, 5440211, ?4-602 11. 54-602 12, 59" 3 20 4? PROTECTION FROM CONTAMINATION Point IN OUT Nlo NIA cos ITE Code COMMENTS Wiping cloths properly stored clean and dry or in a sanitizing solution 21 590 003 2 590 and Food-corded atrium of ulmmle 3 equipment dean M2 11 ,1 2 22 5:35, 90-: Cutting hoards badly ?nned and gamed. Mmood-ooirteu surliious o! utensils. 5 equipment clean 1 23 51mm Proper equmentlutensns storage. handling, to prevent contamination 1 24 590 004 26 Court St Plymouth, MA 02360 Tel: 508-747-1620, Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM PWPM pnorecrrou ?aoni CONTAMTNATION Points IN our NIA cos ITE Code Single service articles are from an approved source, are stored, handled, dispensed, used manner that prevents mntamination 1 No re-use of single service containers for food or cheminl storage 1 1 26 590 004 was!? WATER SUPPLY DISPOSAL Point! IN OUT NIB WA COS ITE Code COMMENTS Water supply is from an approved source and water supply is suf?cient for the operations int! 3 27 55!] 005 Sewage disposal approved Proper disposal of waste water in approved disposalfaoili?ties (ie 23 5% DOS slop sinks) 3 WT IN OUT N10 NIA COS ITE Code Location, installation, maintenance (re dripping faucets, leaking pipes, improperly wasting plF-l 1 29 590 [ms COMMENTS Pumping unsalted preventing cross connection, back saphenago puddlarw. 2 30 590 DDS Adequate handwashing Facilities, easily accessibleI designed, installed ?5?202 12 31 590 005 3 Toilet properly constructed. so? closing doom. Tritium-s in good moan. with 32 soap and towels in dispensers] hand-drying devices, cleaned, covered sanitary dispoal recepticle, handwash signage present Toilet facilities have self-closing doors and doors do 590 005 not open into areas where food is exposed to airborne contamination and are adequately 590 005 separated from food processing and storage areas 2 We AND GROUNDS Point} IN OUT HID MIA EDS ITE Code Suf?ceint covered trash recepti'cles present in adequate number, leak proof, insectlrodent 33 590 005 roof, emptied with adequate frequency. clean. 2 Outsrde premises are free from trash, etc free of narborages, breeding places [or rodents, 34 Insects, and other pests Outside areas (roads, yards, disposal systems) provide adequate 590 ms drainage and do not constitute a source of mntamination Controlled incineration 2 Doors, Windows, and other openings are protected to eliminate entry by insects, 35 590 out: reduntutpt?ls No niridonca u'l pat: present 3 FLOORS. WALLS a. CEILINGS Points IN OUT N?t EDS ITE Code COMMENTS Proper ?oor construction, proper floor covering installed. floors graded with drained as 35 required, floor and wall iuncture covered Floors in good repair and clean Dustless cleaning 590 006 methods used as needed 1 ii Floor by dishwasher needs repair. Willis, ceilings, attache-cl equipment, properly constructed, good rug-rm, dual-i Wan a. GntIJI'lg 37 surfaces as required Dustless cleaning methods used as needed 1 37 590 006 33 Adequate lighting provided for suf?cient candle light Fixtures properly shielded or use of 38 590 006 shatter brood bulbs 1 39 Air quality and ventilation are adequate to remove excessive heat for equipment and rooms 39 590 004 and prevent coniminetlon by dual. andfur other airborne substances 1 40 40 Locker rooms, employee changing areas, provided. located to prevent contamination of 550 004 production areas, and used for storage of employee personal items properly equipped and properly ventilated Dressing rooms are maintained in good physical repair, 1 1 41 41 Insecticides and rodenticidea are used and stored so asto prevent contamination of food Items Detergents, sanitizers and other cleaning supplies are used in a safe, e?ective isu up? manner. Hazardous materiats are kept in their original containers and stored separate from raw materials ?7-202.12, ?7-203 11, ?7?1 01 11, 57-201 11 3 42 Premises maintained free of litter, unnecesary items and articles, cleaning maintenance 42 590 006 equipment properly stored 1 4.3 Separation oI maintenance rooms and equrpment, laundry facHities by partition 1 43 590 004 44 Boiled linens property stored 1 44 599 004 ITE RESPONSIBLE PERSON IN CHARGE Points IN OUT NIO NIA ICOS ITE Code COMMENTS Germ? Fromm" ?2'1?2 12W 3 45 5mm mew-.- -.-. a 24 '22. 13505392. ma ca macdenald a 2a.:9 mass-er PIC is present, knowledgeable, understands sanitary controls, demonstrates 45 330,002 knowledge, performs duties. 52-10111 3 590.002 Anc 25 Court St. Plymouth, MA 02360 Tel: 508-747-1620, Extension 10113 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM ITEM HIGHLY SUSCEPTABLE POPULATIONS Points IN OUT NIO NIA EDS ITEM Code 47 Paetuenzed foods used: prohibited foods not offered ?3?601 11 47 3 at sea nos 31-5 we" FOODICOLOR Points IN OUT NIO NIA COS- Code 43 Food additives:approved and property used ?3?202 12 2 48 590 003 IITEM EQUIPMENT AND UTENSILS Points IN OUT HID Nf? COS Code COMMENTS All utensils and equipment are cleaned and sanitized at intervals that are trequent enough to 49 550 004 avoid offood products woe 11 2 50 Instruments and controls used for measuring. regulating. or recording temperature, pH, acid'ty. water 50 activity. or other conditions are accurate and adequately maintained and calibrated 590 004 1 51 Moltuslran Shell?sh Tanks maintained. tested. and logs kept 1 51 590 004 ITEM Mm H-EALTH PROCEDURES Points IN OUT NIO NIA :05 ITE Code COMMENTS 52 PI Procedures for responding to vomiting 8.: diarrhea] events ?2-501 ll 1 52 590 002 Must have wrien Norovirus control policy. CONSUMER ADVISORY POSTED Points IN OUT NIO NIA cos ITEM Code COMMENTS Comm Advisory Posted ?3?603 ll 1 I 53 sec [103 ITEM Plantain? SPECIAL PROCESSES Points IN OUT MID NIA EDS ITEM Code 54 FILE Required records available; shellstock tags, parasrte destruction.Time As a Public Health 54 590 no: Control, required logs. 63-203 12. ?3-40111, 53-402 12. 3 I 55 Comm-ice with tmmluedjrm?HLC?CP ?his: [031235-391 l-l i: 55 311""- CONFORMANCE WITH APPROVED PROCEDURES Poinn IN OUT NIO NIA COS ITEM Code COMMENTS Alle en Certificate it 590.011lAl 1.29.24 micheie met Anti-Choking l- 590.011[Al Need training F.O.G. Local BOH Regulation 1 local Not having hood cleaned and tagged Firm is currently licensed by the regulatory authority havingjurisdiction it: local ITEM RECORD CHECKLIST ITEM Code COMMENTS Water quality and supply records. grease trap cleaning record. ansul system cleaning records and tags current. Fire exiinquisherta 5 current 51: Employee training records it Tomparotuio control round-is I Equipment monitoring and maintenance records it Calibration records at Sanitation records p: Required Logs; Time as a Public Health Control. Receiving Temperature. parasite 550 008 destmdion 5: Pest control retards Variance request and approval. Time as a Public Health Control Procedure 590 (maid) Inspection records (a . incoming product. facility. production area) 1 ITEMS OBSERVED IN: In Compliance In Red Risk Factors Observed (Priority) pts. Dad noted 3 OUT: Out of Compliance In Blue Good Retail Practices Observed {Priority Found ation. CoreLpts. Deductecl 8 Not Observed Total Non-Compliant Observations total points deducted 11 Not Applicable SCORE: 89 C05: Corrected on Sight 'Violations cited must be corrected within the time frames in section 8405.11 or in dates otherwise written in the report. R: Repeat Violation 26 Court St. Plymouth, MA 02360 Tel: 508-747-1620. Extension 10118 Town of Plymouth Public Health Department RETAIL FOOD INSPECTION FORM OFFICIAL ORDER FOR CORRECTION: Based on an inspection today, the items checked indicate violations of the Plymouth Board of Health Food Regulation] 2013 Federal Food and Drug Administration Food Code. This report, when signed below or delivered using electronic mail, by a Plymouth Public Health Department inspector or an agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you have a right to a hearing with the Board of Health. Your request for a Board of Health hearing must be in writing and submitted to the Public Health Department at the above address within ten (10) calendar days of receipt of this order. Temperatures Taken: ADDITIONAL OTES: 150 to 200 student meals lunches 90 breakfasts 26 Court St. Plymouth, MA 02360 Tel: 508-747-1520, Extension 10118