Date: Time: Report: 04/27/17 11:00:00 1006171058 Minnesota Department of Health Environmental Health, FPLS P.O. Box 64975 St. Paul, MN 55164-0975 651-201-4500 Page 1 Location: 195 US Highway 2 Proctor, MN55810 St. Louis County, 69 Establishment Info: ID #: 0022458 Risk: High Announced Inspection: No License Categories: HOSP, FBLB, FBTW, FBLM Operator: Phone #: 2186280628 Expires on: 12/31/17 ID #: 28220 The violations listed in this report include any previously issued orders and deficiencies identified during this inspection. Compliance dates are shown for each item. The following orders were issued during this inspection. 3-500B Microbial Control: hot and cold holding 3-501.16B ** Critical Item ** MN Rule 4626.0395 Maintain all cold, potentially hazardous foods at 41 degrees F (5 degrees C) or below under mechanical refrigeration. MEATLOAF AND PORTIONED CHICKEN IN THE SERVICE LINE PREP COOLER TOP WERE ABOVE 41 F ( 55 F AND 49 F). CONTAINERS WERE FILLED PRETTY HIGH AND THE MEATLOAF AND CHICKEN IN THE BOTTOM HALF OF THE CONTAINERS WERE APPROPRIATE TEMPS. Corrected on Site 4-600 Cleaning Equipment and Utensils 4-602.11E ** Critical Item ** MN Rule 4626.0845 Clean surfaces contacting food that is not potentially hazardous: 1. at any time when contamination may have occurred; 2. at least once every 24 hours for iced tea dispensers and consumer self-service utensils; 3. before restocking condiment dispensers, display containers and other consumer self-service equipment and utensils; 4. at a frequency specified by the manufacturer for ice bins, beverage dispensing nozzles, enclosed components of ice makers, beverage dispensing lines or tubes, coffee bean grinders, and water vending equipment. THE ROLHFING BEER TAPS HAD A BUILD-UP OF YEAST, CLEAN TAPS AND LINES AT A FREQUENCY TO LIMIT BUILD-UP. Comply By: 04/27/17
Page 2 1-100 Food Manager Certification 1-101.03MN MN Rule 4626.2010 Post the state certified food manager certificate in a conspicuous place in the establishment. POST THE CERTIFIED FOOD MANAGER CERTIFICATE IN A CONSPICUOUS LOCATION IN THE RESTAURANT. Comply By: 04/27/17 3-300C Protection from Contamination: equipment/utensils, consumers 3-304.12B MN Rule 4626.0275 Store the bulk food dispensing utensil in the food with the handle extending out of the food, or in a protective enclosure attached or adjacent to the enclosure with the utensil on a tether of easily cleanable material which is short enough to prevent the utensil from making contact with the floor. MIXING BOWL WAS BEING USED AS A SCOOP IN THE CRACKER MEAL. BOWL WAS REMOVED AND A SCOOP WITH A HANDLE WAS PROVIDED. Corrected on Site 6-500 Physical Facility Maintenance/Operation and Pest Control 6-501.12A MN Rule 4626.1520 Clean and maintain clean all physical facilities. THE FRP WALL BEHIND THE PREP COOLERS IN THE SERVICE LINE OF THE KITCHEN HAD A BUILD-UP OF GREASE AND DEBRIS. CLEAN TO REMOVE BUILD-UP OR REPLACE FRP TO BE SMOOTH AND CLEAN. Comply By: 05/27/17 8-300 License to Operate 8-301.12 MN Statutes 157.16 Subd. 4. Post the original license certificate issued from the regulatory authority in a conspicuous location at the establishment. Mobile food units, food carts, and seasonal temporary food stands require fixed, non-transferable decals with the initial license and each calendar year of license renewal. POST THE LICENSE IN A CONSPICUOUS LOCATION IN THE RESTAURANT. Comply By: 04/27/17 Surface and Equipment Sanitizers Quaternary Ammonia: = 200 PPM at Degrees Fahrenheit Location: SANITIZER BUCKET ON KITCHEN LINE Hot Water: = 161 at Degrees Fahrenheit Location: DISHWASHER IN KITCHEN Quaternary Ammonia: = 400 PPM at Degrees Fahrenheit Location: SANITIZER BUCKET NEAR SALAD STATION
Page 3 Hot Water: = 168 F at Degrees Fahrenheit Location: CATERING DISHWASHER Quaternary Ammonia: = 400 PPM at Degrees Fahrenheit Location: SANITIZER BUCKET IN BAR Iodine: = 25 PPM at Degrees Fahrenheit Location: DISHWASHER IN BAR Food and Equipment Temperatures Temperature: 34 Degrees Fahrenheit - Location: SLICED TOMATOES- SERVICE LINE TOP Temperature: 34 Degrees Fahrenheit - Location: MASHED POTATOES- SERVICE LINE TOP Temperature: 39 Degrees Fahrenheit - Location: RAW CHICKEN- SERVICE LINE BOTTOM Temperature: 55 Degrees Fahrenheit - Location: MEATLOAF- SERVICE LINE PREP TOP (TOP 1/2) Violation Issued: Yes Temperature: 37 Degrees Fahrenheit - Location: MEATLOAF- SERVICE LINE PREP TOP (BOTTOM 1/2) Temperature: 49 Degrees Fahrenheit - Location: PRECOOKED PORTIONED CHICKEN- SERVICE LINE PREP TOP ( TOP 1/2) Violation Issued: Yes Temperature: 40 Degrees Fahrenheit - Location: PRECOOKED PORTIONED CHICKEN- SERVICE LINE PREP TOP (BOTTOM 1/2) Temperature: 37 Degrees Fahrenheit - Location: POT ROAST- SERVICE LINE BOTTOM Temperature: 40 Degrees Fahrenheit - Location: 1/2 CHICKENS- SERVICE LINE BOTTOM
Page 4 Temperature: 33 Degrees Fahrenheit - Location: KIELBASA SAUSAGE- SERVICE LINE BOTTOM Temperature: 172 Degrees Fahrenheit - Location: TURKEY GRAVY Temperature: 178 Degrees Fahrenheit - Location: BEEF GRAVY Process/Item: Under Counter Cooler Temperature: 35 Degrees Fahrenheit - Location: HAMBURGER PATTIES Temperature: 37 Degrees Fahrenheit - Location: CHICKEN- PREP TOP Temperature: 35 Degrees Fahrenheit - Location: SLICED TOMATOES- PREP TOP Temperature: 37 Degrees Fahrenheit - Location: PRIME RIB- PREP BOTTOM Process/Item: Upright Freezer Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- TRUE Temperature: 154 Degrees Fahrenheit - Location: LUCA SAUCE- HOT HELD ON STOVE TOP Temperature: 36 Degrees Fahrenheit - Location: CUT CHERRY TOMATOES- SALAD PREP TOP Temperature: 40 Degrees Fahrenheit - Location: SOUR CREAM- SALAD PREP TOP Temperature: 39 Degrees Fahrenheit - Location: CHERRY TOMATOES- SALAD PREP BOTTOM Temperature: 38 Degrees Fahrenheit - Location: CORN SALSA- SALD PREP BOTTOM
Page 5 Temperature: 40 Degrees Fahrenheit - Location: LETTUCE- SALAD PREP TOP Temperature: 37 Degrees Fahrenheit - Location: SALAD PREP BOTTOM Temperature: 175 Degrees Fahrenheit - Location: BAKED POTATOES- ALTO SHAM Process/Item: Walk-In Cooler Temperature: 40 Degrees Fahrenheit - Location: PRECOOKED NOODLES- CATERING WALK-IN Process/Item: Walk-In Cooler Temperature: 41 Degrees Fahrenheit - Location: SWISS CHEESE- CATERING WALK-IN Temperature: 142 Degrees Fahrenheit - Location: MEATBALLS- ALTO SHAM Temperature: 174 Degrees Fahrenheit - Location: ALFREDO SAUCE ON THE STOVETOP Process/Item: Walk-In Cooler Temperature: 40 Degrees Fahrenheit - Location: PRECOOKED NOODLES Process/Item: Walk-In Cooler Temperature: 35 Degrees Fahrenheit - Location: WHOLE CHICKEN Process/Item: Upright Cooler Temperature: 35 Degrees Fahrenheit - Location: THOUSAND ISLAND DRESSING- DESSERT/SALAD COOLER Process/Item: Under Counter Cooler Temperature: 39 Degrees Fahrenheit - Location: TURKEY NOODLES SOUP Process/Item: Cooking Temperature: 183 Degrees Fahrenheit - Location: CHEESEBURGER Process/Item: Cooking Temperature: 158 Degrees Fahrenheit - Location: SALMON
Page 6 Process/Item: Cooking Temperature: 185 Degrees Fahrenheit - Location: STEAK Process/Item: Counter Top Freezer Temperature: Degrees Fahrenheit - Location: FOODS FROZEN- ICE CREAM COOLER Temperature: 152 Degrees Fahrenheit - Location: CHICKEN WILD RICE SOUP Temperature: 174 Degrees Fahrenheit - Location: TOMATO BASIL SOUP Process/Item: Under Counter Cooler Temperature: 38 Degrees Fahrenheit - Location: LEMONS- BAR COOLER Process/Item: Cooling Temperature: 140 Degrees Fahrenheit - Location: WHISKEY SAUCE- JUST PLACED IN ICE BATH @~ 10 MINUTES COMMENTS: Total Critical Orders This Report: Total Non-Critical Orders This Report: INSPECTION WAS ACCOMPANIED BY GENERAL MANAGER BROOK AND HEAD CHEF GINA. COLD HOLDING TEMPS: MEATLOAF AND PORTIONED CHICKEN IN THE SERVICE LINE PREP COOLER TOP WERE ABOVE 41 F ( 55 F AND 49 F). CONTAINERS WERE FILLED PRETTY HIGH AND THE MEATLOAF AND CHICKEN IN THE BOTTOM HALF OF THE CONTAINERS WERE APPROPRIATE TEMPS. STAFF TOOK OUT HALF OF THE CONTAINERS AND DISCUSSED KEEPING SMALLER WORKING PORTIONS OUT AT A TIME. PREP COOLER IS ALSO DIRECTLY BEHIND THE BROILER STOVE WHICH GENERATES A LOT OF HEAT, DISCUSSED KEEPING THE COOLER LIDS CLOSED AS MUCH AS POSSIBLE. OBSERVED GOOD HAND WASHING AND GLOVE USE BY STAFF, DISCUSSED THE IMPORTANCE OF LIMITING BARE HAND CONTACT WITH ALL READY TO EAT FOODS. DISCUSSED THE EMPLOYEE ILLNESS LOGS AND EXCLUDING EMPLOYEES SICK WITH SYMPTOMS OF VOMITING AND/OR DIARRHEA UNTIL 24 HOURS AFTER THEIR LAST SYMPTOM. OBSERVED STAFF USING AN ICE BATH TECHNIQUE TO COOL THEIR WHISKEY SAUCE. DISCUSSED COOLING PRACTICES OF THE ESTABLISHMENT. COOLING FACT SHEET AND LOG LEFT AT TIME OF INSPECTION. 2 4
Page 7 REPORT EMAILED TO: PROCTOR@BLACKWOODS.COM NOTE: All new food equipment must meet the applicable standards of NSF International. Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the Minnesota Department of Health inspection report number 1006171058 of 04/27/17. Certified Food Manager: Certification Number: Brook A. Rodberg FM62774 Expires: 07/23/18 Inspection report reviewed with person in charge and emailed. Signed: Brook Rodberg General Manager Signed: Callie Bursch Public Health Sanitarian Duluth District Office 218-302-6173 callie.bursch@state.mn.us
Report #: 1006171058 Minnesota Department of Health Environmental Health, FPLS P.O. Box 64975 St. Paul, MN 55164-0975 Food Establishment No. of RF/PHI Categories Out No. of Repeat RF/PHI Categories Out Legal Authority MN Rules Chapter 4626 Address City/State Zip Code Telephone 195 US Highway 2 Proctor, MN 55810 2186280628 License/Permit # Permit Holder Purpose of Inspection Est Type 0022458 FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item Date Time In Mark "X" in appropriate box for COS and/or R Time Out Risk Category H IN= in compliance OUT= not in compliance N/O= not observed N/A= not applicable COS= corrected on-site during inspection R= repeat violation Compliance Status COS R 1A N/A Demonstration of Knowledge Certified food manager, duties 1B PIC knowledgeable; duties & oversight Employee Health 2 Management awareness; policy present 3 4 5 6 7 8 9 10 11 12 13 14 15 Proper use of reporting, restriction & exclusion Good Hygenic Practices N/O Proper eating, tasting, drinking, or tobacco use N/O No discharge from eyes, nose, and mouth Preventing Contamination by Hands N/O Hands clean & properly washed N/A N/O Hand contact with RTE foods restricted Adequate handwashing facilities supplied & accessible Approved Source Food obtained from approved source N/A N/O Food received at proper temperature N/A N/O N/A N/A Food in good condition, safe, & unadulterated Required records available; shellstock tags, parasite destruction Protection from Contamination Food separated/protected from cross contamination Food contact surfaces: cleaned & sanitized Proper disposition of returned, previously served, reconditioned, & unsafe food Compliance Status Potentially Hazardous Food Time/Temperature 16 N/A N/O Proper cooking time & temperature 17 N/A N/O Proper reheating procedures for hot holding 18 N/A N/O Proper cooling time & temperature 19 N/A N/O Proper hot holding temperatures 20 21 22 N/A Consumer Advisory 23 N/A in MN Consumer advisory for raw or undercooked foods 24 25 26 GOOD RETAIL PRACTICES Proper cold holding temperatures N/A N/O Proper date marking & disposition N/A N/O Time as a public health control: procedures & record N/A in MN N/A Highly Susceptible Populations Pasteurized foods used; prohibited foods not offered Chemical Food additives: approved & properly used Toxic substances properly identified, stored, & used Conformance with Approved Procedures 27 N/A Compliance with HACCP plan and variance 3 0 04/27/17 11:00:00 Risk factors (RF) are improper practices or proceedures identified as the most prevalent contributing factors of foodborne illness or injury. Public Health Interventions (PHI) are control measures to prevent foodborne illness or injury. Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods. Mark "X" in box if numbered item is not in compliance Mark "X" in appropriate box for COS and/or R COS=corrected on-site during inspection R= repeat violation Safe Food and Water 28 Pasteurized eggs used where required 29 30 31 32 33 34 Water & ice from approved source Variance obtained for specialized processing methods, documentation on file Food Temperature Control Proper cooling methods used; adequate equipment for temperature control Plant food properly cooked for hot holding Approved thawing methods used Thermometers provided and accurate Food Protection 35 Food properly labled; original container 36 Insects, rodents, & animals not present; no unauthorized persons 37 38 39 40 N/A N/A Food Recalls: Contamination prevented during food prep, storage & display Personal cleanliness Wiping cloths: properly used & stored Washing fruits & vegetables COS R 41 X In-use utensils: properly stored 42 43 45 Proper Use of Utensils Utensils, equipment & linens: properly stored, dried, & handled Single-use & single service articles: properly stored & used 44 Gloves used properly 46 47 48 49 50 51 52 53 54 55 56 X X Utensil Equipment and Vending Food & non-food contact surfaces cleanable, properly designed, constructed, & used Warewashing facilities: installed, maintained, & used; test strips Non-food contact surfaces clean Physical Facilities Hot & cold water available; adequate pressure Plumbing installed; proper backflow devices Sewage & waste water properly disposed Toilet facilities: properly constructed, supplied, & cleaned Garbage & refuse properly disposed; facilities maintained Physical facilities installed, maintained, & clean Adequate ventilation & lighting; designated areas used Compliance with MCIAA & Choking Poster Compliance with licensing & plan review COS X COS X R R Person in Charge (Signature) Date: 04/28/17 Inspector (Signature) Follow-up Needed: YES NO (Circle one) Follow-up Date: / /