Date: Time: Report: 04/19/17 14:15:00 1006171053 Minnesota Department of Health Environmental Health, FPLS P.O. Box 64975 St. Paul, MN 55164-0975 651-201-4500 Page 1 Location: 4767 West Arrowhead Road Hermantown, MN55810 St. Louis County, 69 Establishment Info: ID #: 0023268 Risk: High Announced Inspection: No License Categories: HOSP, FBLB, FBME, FBTW Operator: PK & JS Inc. Phone #: 2187261381 Expires on: 12/31/17 ID #: 29742 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 previously issued between 04/07/14 and 04/25/16 have NOT been corrected. 4-200 Equipment Design and Construction 4-201.11B MN Rule 4626.0505 Provide or replace food service equipment to meet NSF International Standards. 07 APR 2014: KENMORE UPRIGHT FREEZER AND THE BLACK AND DECKER TOASTER ARE FOR HOUSEHOLD USE ONLY. 27 MAR 2015: HOUSEHOLD TOASTER HAS BEEN REPLACED WITH AN NSF TOASTER. 4/19/17 THE KENMORE FREEZER IS STILL PRESENT. Issued on: 04/07/14 Comply By: 04/07/15 2-400 Hygenic Practices 2-401.11 MN Rule 4626.0105 Discontinue consuming food, use of unapproved beverage containers, or use of tobacco in any form in food preparation or utensil washing areas. MULTIPLE BEVERAGE CUPS IN THE KITCHEN WERE USED WITHOUT LIDS. USE COVERED CONTAINERS FOR EMPLOYEE BEVERAGES. Issued on: 04/25/16 Comply By: 04/25/16 3-500A Microbial Control: cooling 3-501.14A MN Rule 4626.0385 Cool cooked potentially hazardous food: 1. from 140 degrees F (60 degrees C) to 70 degrees F (21 degrees C) within two hours; and 2. from 70 degrees F (21 degrees C) to 41 degrees F (5 degrees C) or below, within four hours. 4/19/17 FRIED ONIONS MADE THAT AFTERNOON WERE STORED IN A CLOSED PLASTIC CONTAINER IN AN UPRIGHT COOLER AT 95 F. Issued on: 04/25/16 Comply By: 04/25/16
Page 2 3-500C Microbial Control: date marking 3-501.17A MN Rule 4626.0400 Mark the date of preparation on all refrigerated, ready-to-eat potentially hazardous food prepared in the food establishment and held for more than 24 hours. This will help ensure the food is consumed by the "use by" date, which is seven calendar days from the date of preparation including the date of preparation. SOME ITEMS IN THE WALK-IN COOLER, 3-DOOR COOLER, AND TRAULSEN 3-DOOR FREEZER DID NOT HAVE DATES. ITEMS PREPARED THAT DAY WERE DATED OR THROWN OUT BY LUKE. 4/19/17 SAME AS PREVIOUS. Issued on: 04/25/16 Comply By: 04/25/16 5-400 Sewage 5-402.12 MN Rule 4626.1190 Provide an approved indirect connection between the sewer system and any drain line originating from food storage, manufacturing and retail display equipment including portable equipment, ice bins, salad bars, cocktail stations, and running water dipper wells. DRAIN LINES FROM THE ICE BIN WERE DIRECTLY IN THE PVC DRAIN PIPE WITHOUT A 1 INCH AIR GAP. CORRECT BY CREATING A 1 INCH AIR GAP. Issued on: 04/25/16 Comply By: 07/25/16 6-500 Physical Facility Maintenance/Operation and Pest Control 6-501.12A MN Rule 4626.1520 Clean and maintain clean all physical facilities. FREEZERS HAD SOME FOOD/ SPILLAGE ON THE FLOOR, THE DRYING RACK WAS DIRTY, AND WALL/CEILING ABOVE STEAMER WAS DIRTY. CLEAN AND MAINTAIN EQUIPMENT AND FACILITY. Issued on: 04/25/16 Comply By: 05/09/16 The following orders were issued during this inspection. 3-300A Protection from Contamination: limit hand contact, tasting 3-301.11 MN Rule 4626.0225 Use spatulas, tongs, deli tissue or other dispensing equipment to limit direct hand contact with food or ice. OBSERVED CHEF USING BARE HAND CONTACT WHEN GRABBING TOAST AND PUTTING SHREDDED CHEESE ONTO A FINISHED DISH. Comply By: 04/19/17 4-500 Equipment Maintenance and Operation 4-501.114C3 MN Rule 4626.0805 Provide and maintain an approved quaternary ammonium compound sanitizing solution in water with 500 ppm hardness or less, a minimum temperature of 75 degrees F (24 degrees C) and a concentration between 200-400 ppm. THE 3 COMP SINK BEING USED TO HOLD SANITIZER AND TOWELS IN THE BAR WAS
Page 3 READING 0 PPM. STAFF USE A CONCENTRATED QUAT SANITIZER THAT WAS ALMOST EMPTY. CHEMICAL CAN WEAKEN OVER TIME, DISCUSSED TESTING THE 3 COMP SINK REGULARLY TO ENSURE PROPER LEVELS. Comply By: 04/19/17 4-300 Equipment Numbers and Capacities 4-302.14 MN Rule 4626.0715 Provide an appropriate test kit to accurately measure sanitizer concentration. ESTABLISHMENT NEEDS NEW TEST STRIPS FOR THE CHLORINE DISHWASHER. HAVE STAFF USE TEST STRIPS FOR THE DISHWASHER AND QUAT. DISPENSERS TO ENSURE PROPER SANITIZING LEVELS ARE BEING MET. Comply By: 04/26/17 4-500 Equipment Maintenance and Operation 4-501.11AB MN Rule 4626.0735 All equipment and components shall be in good repair and maintained and adjusted in accordance with manufacturer's specifications. THE GASKET ON THE WALK-IN COOLER IS PULLING AWAY AND THE CORNER OF THE DOOR HAS BEEN WARPED/BROKEN. REPAIR DOOR TO PROVIDE A GOOD SEAL. ALSO THE SPRAY HOSE HANDLE WAS FIED WITH DUCT TAPE WHICH ISN'T EASILY CLEANABLE. A NEW HANDLE HAS BEEN ORDERED. Comply By: 10/19/17 6-500 Physical Facility Maintenance/Operation and Pest Control 6-501.11 MN Rule 4626.1515 Maintain the physical facilities in good repair. SEE COMMENTS. Comply By: 04/20/18 Surface and Equipment Sanitizers Chlorine: = 100 PPM at Degrees Fahrenheit Location: DISHWASHER Quaternary Ammonia: = 400 PPM at Degrees Fahrenheit Location: SANITIZER DISPENSER Quaternary Ammonia: = 0 PPM at Degrees Fahrenheit Location: BAR TOWELS IN 3 COMP SINK Violation Issued: Yes Food and Equipment Temperatures Process/Item: Prep Cooler Temperature: 37 Degrees Fahrenheit - Location: DICED TOMATOES- SERVICE LINE TOP
Page 4 Process/Item: Prep Cooler Temperature: 39 Degrees Fahrenheit - Location: SLICED TOMATOES- SERVICE LINE TOP Process/Item: Prep Cooler Temperature: 38 Degrees Fahrenheit - Location: DICED HAM- SERVICE LINE BOTTOM Process/Item: Steam Table Temperature: 178 Degrees Fahrenheit - Location: CHILI Process/Item: Steam Table Temperature: 181 Degrees Fahrenheit - Location: MASHED POTATOES Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- TRAULSEN Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- FRIGIDAIRE Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- KENMORE Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- ABC CHINESE FOOD FREEZER Temperature: 40 Degrees Fahrenheit - Location: BEEF STROGANOFF- 3 DOOR Temperature: 41 Degrees Fahrenheit - Location: DYNOMITE CHICKEN WRAP MI- 3 DOOR Temperature: 40 Degrees Fahrenheit - Location: ALFREDO SAUCE- 3 DOOR Process/Item: Cooling Temperature: 95 Degrees Fahrenheit - Location: FRIED ONIONS- 3 DOOR COOLER @~1.5 HOURS Process/Item: Hot Holding Temperature: 170 Degrees Fahrenheit - Location: CABBAGE HAM SOUP
Page 5 Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- SUPERIOR Temperature: Degrees Fahrenheit - Location: ALL FOODS FROZEN- ABC Process/Item: Counter Top Cooler Temperature: 35 Degrees Fahrenheit - Location: RANCH DRESSING- STARBUCKS COOLER Process/Item: Walk-In Cooler Temperature: 37 Degrees Fahrenheit - Location: THOUSAND ISLAND DRESSING Process/Item: Walk-In Cooler Temperature: 40 Degrees Fahrenheit - Location: COLESLAW Process/Item: Walk-In Cooler Temperature: 38 Degrees Fahrenheit - Location: HAM Temperature: 35 Degrees Fahrenheit - Location: BEANS- PEPSI COOLER IN BAR Temperature: 36 Degrees Fahrenheit - Location: MILK- KEG COOLER IN BAR COMMENTS: Total Critical Orders This Report: Total Non-Critical Orders This Report: DISCUSSED WITH STAFF THE IMPORTANCE OF LIMITING BARE HAND CONTACT WITH ALL READY TO EAT FOODS BY USING GLOVES, TONGS, DELI TISSUE, ETC. ALSO TO SWITCH GLOVES WHEN CHANGING DIFFERENT TASKS AND GOING FROM RAW FOODS TO COOKED. DISCUSSED EMPLOYEE ILLNESS AND THE ECLUSION OF EMPLOYEES SICK WITH SYMPTOMS OF VOMITING AND/OR DIARRHEA UNTIL 24 HOURS AFTER THEIR LAST SYMPTOM. PHYSICAL FACILITIES IN NEED OF MAINTENANCE: THE STAINLESS STEEL PANEL BEHIND THE FRYERS/STOVE TOP HAS POPPED OUT OF PLACE LEAVING A LARGE GAP. RE-SEAL THE PANEL TO PROVIDE A SMOOTH AND EASILY CLEANABLE SURFACE. THE FLOORING IN THE BAR IS ALSO IN NEED OF REPLACEMENT. THE VINYL HAS WORN AWAY IN MULTIPLE SPOTS AND BARE CONCRETE FLOORING IS EPOSED AROUND THE KEG COOLERS AND BACK WALL. 6 5
Page 6 DISCUSSED COOLING WITH STAFF AND OWNER AND FACT SHEET AND COOLING LOGS WERE LEFT AT TIME OF INSPECTION. DISCUSSED USING SHALLOW METAL CONTAINERS, CRACKING CONTAINERS TO ALLOW HEAT TO ESCAPE, AND USING AN ICE BATH WHILE STIRRING WHILE IN THE ICE BATH TO COOL EVENLY. TEMP THE FOODS TO ENSURE THEY ARE COOLING FROM 140 F-70 F IN 2 HOURS THEN FROM 70 F- 41F IN 4 ADDITIONAL HOURS. DISCUSSED DATE MARKING WITH STAFF AND FACT SHEET LEFT AT TIME OF INSPECTION. DATE MARK ALL POTENTIALLY HAZARDOUS FOODS PREPARED IN THE ESTABLISHMENT AND KEPT LONGER THAN 24 HOURS OR FROZEN TO ENSURE FOODS ARE USED OR DISCARDED IN 7 CALENDAR DAYS. REPORT EMAILED TO PKTWINS@HOTMAIL.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 1006171053 of 04/19/17. Certified Food Manager: Certification Number: Pete M. Kilroy FM50968 Expires: 10/27/18 Inspection report reviewed with person in charge and emailed. Signed: Pete M. Kilroy Owner Signed: Callie Bursch Public Health Sanitarian Duluth District Office 218-302-6173 callie.bursch@state.mn.us
Report #: 1006171053 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 4767 West Arrowhead Road Hermantown, MN 55810 2187261381 License/Permit # Permit Holder Purpose of Inspection Est Type 0023268 PK & JS Inc. 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 "" 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 5 3 04/19/17 14:15:00 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 "" in box if numbered item is not in compliance Mark "" 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 In-use utensils: properly stored 42 43 45 46 47 Proper Use of Utensils Utensils, equipment & linens: properly stored, dried, & handled Single-use & single service articles: properly stored & used 44 Gloves used properly 48 49 50 51 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 52 Garbage & refuse properly disposed; facilities maintained 53 Physical facilities installed, maintained, & clean 54 55 56 Adequate ventilation & lighting; designated areas used Compliance with MCIAA & Choking Poster Compliance with licensing & plan review COS COS R R Person in Charge (Signature) Date: 04/20/17 Inspector (Signature) Follow-up Needed: YES NO (Circle one) Follow-up Date: / /