CRITICAL VIOLATION RISK FACTORS

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1 Food Service Establishment Inspection Establishment Name: Address: 2104 OLD LEXINGTON ROAD City: WINSTON SALEM State: NC Zip: Permittee: JOSE & MILCIADES SORTO Mailing Address: 2104 OLD LEXINGTON ROAD City: WINSTON SALEM State: Zip: NC Department of Environment & Natural Resources Score: [.2606(b)] = 75.5 Date: 0 3 / / Time: 0 1 : 4 5 Status Code: A Risk: I II III IV County: 34 Current Establishment ID: Previous Establishment ID: Address: Lat. Long. CRITICAL VIOLATION RISK FACTORS Critical Violation Risk Factors = Contributing factors that increase the chance of developing foodborne illness NA = Not Applicable NO = Not Observed GC = General Comment CDI = Corrected During Inspection R = Repeat Violation # NA NO Pts GC CDI R Inspection Re-inspection Visit Name Change Status Change Employee Health Good Hygiene Practices Preventing Contamination by Hands Approved Source CV Visit CV Follow-up Protection from Contamination Food contact surfaces cleaned & sanitized; approved methods and sanitizers Potentially Hazardous Food Proper hot holding temperatures Seating: Personnel with infectious or communicable diseases restricted Proper employee beverage or tobacco use Hands clean and properly washed Minimal bare hand contact with foods Handwashing facilities provided Food obtained from an approved source Food received at proper temperature Food in good condition, safe and unadulterated Shellstock tags retained Wastewater Systems: Water Supply: Municipal/Community Water sample taken today? ,.2616, ,.2610,.2612,.2615, ,.2610,.2611,.2612,.2614,.2615,.2617,.2618,.2619,.2622 Food protected during storage, handling, display, service & transportation; written notice for clean plates Proper handling of returned, previously served, and adulterated food Proper cooking time and temperature Proper cooling Proper reheating procedures 5 2 Proper cold holding temperatures Time as a public health control, procedures & records Municipal/Community.2609,.2612 On-Site System On-Site System Item Temp hot water 3 comp sink 136 TEMPERATURE OBSERVATIONS Item Temp Item Temp beef walk in cooler 42 cream walk in cooler 42 shrimp reach in cooler 42 chicken reach in cooler 43 rice walk in cooler 43 ground beef walk in cooler 44 atol stove top hot hold ing 156 milk reach in cooler 42 cooked walk in cooler 41 COMMENTS: DENR 4007 (revised 01/08) Page 1 of 2

2 Food Service Establishment Inspection NC Department of Environment & Natural Resources Establishment Name: Date: 03/21/2011 Current Establishment ID: # NA NO COMMENTS: GOOD RETAIL PRACTICES Preventitive measures to control the introduction of pathogens, chemicals, and physical objects into foods Pts Toxic substances properly identified, stored, used Consumer Advisory Consumer advisory provided Water Supply Source in accordance with 15A NCAC 18A.1700; hot & cold water available, under pressure Food Temperature Control Refrigeration and freezer capacity sufficient Proper cooling methods used Proper thawing methods used Thermometers provided and accurate Food Storage Dry food stored properly & labeled accordingly Original container for storage of milk & shellfish Prevention of Food Contamination Insects, rodents, and animals not present Clean clothes, hair restraints Linens, cloths, & aprons properly used & stored Washing fruits & vegetables Not used for domestic purposes In-use utensils properly stored Utensils & equipment properly stored, air-dried, handled Single-use/single-service articles properly stored, handled, used Food & non-food contact surfaces easily cleanable & in good repair Approved warewashing facilities of sufficient size Warewashing facilities maintained; test strips used Food service equipment and utensils approved Non-food contact surfaces clean Wastewater discharged into approved, properly operating wastewater treatment & disposal system; other by-products disposed of properly No cross-connections Toilet and lavatory facilities; supplied, properly constructed, clean, good repair, signs provided Garbage properly handled & disposed; containers properly maintained Floors, walls, ceilings properly constructed, clean, in good repair Meets illumination requirements; shielded; lighting & ventilation clean & in good repair Storage spaces clean, storage above floor; approved storage for mops, brooms, hoses, & other items Doors self-closing where required; all windows screened Food Safety Knowledge 49 Successfully completed approved food safety training Inspection by: Report Received by: Chemical Purpose: General Statute 130A-248 requires the Commission for Health Services to adopt rules governing the sanitation of facilities where food or drink is provided or served for pay. 15A NCAC 18A.2604 specified the contents of an inspection form to record the results of inspections made of such facilities. This form is developed to be used in making inspections of restaurants, food stands, drink stands, delicatessens, school lunchrooms, educational food services, commissaries, meat markets, and other similar establishments. Preparation: Local environmental health specialists shall complete the form every time an inspection is conducted. Prepare an original and two copies for: 1. Original to be left with the responsible person. 2. Copy for the local health department. 3. Copy for the Environmental Health Services Section. Disposition: This form may be destroyed in accordance with Standard-8.B.6., Inspection Records, of the Records Disposition Schedule, published by the N.C. Division of Archives and History. Additional forms may be ordered from:, 1632 Mail Service Center, Raleigh, NC (Courier ).2612 Utensils and Equipment.2612,.2613,.2617,.2618,.2619,.2620,.2621 Physical Facilities.2618, ,.2622, ,.2612, ,.2616,.2617,.2626,.2633 Proper Use of Utensils.2612,.2618,.2620, ,.2624,.2625,.2626,.2627,.2628,.2630,.2631,.2632,.2633 Total Deductions.2606 EHS I.D. #: GC R ATTACHMENTS: 1938-Faircloth, Craig Page 2 of 2

3 N.C. Department of Environment and Natural Resources Name: Time In: : ID: Time Out: : Street: 2104 OLD LEXINGTON ROAD Total Time: 4 hrs 0 minutes City: WINSTON SALEM am pm am pm 2 Several employee beverages were found on the make unit and prep table with no lids or straws. Store all employee beverages on lower shelves away from all food contact areas to prevent contamination. 3 Employees observed moving between tasks without properly washing their hands only rinsing them. Employees must properly wash their hands when moving between tasks or after returning to work after leaving their station. 5 G.C. No soap or paper towels were provided at any of the hand wash sinks in the kitchen area. All hand wash sinks must have soap and paper towels. The hand sink in the front service area was being used at the time of this inspection. 10 Chicken and shrimp were found stored in the same container and shell eggs were found stored above shrimp in a reach in cooler. Keep all food items in refrigerated storage separated according to species. Keep all food items on shelves in refrigerated storage in order of final cooking, those with the highest cooking temperatures on the bottom and so on. E.g. (from top to bottom shelves) Poultry, ground beef, eggs, pork, seafood, whole muscle beef, ready to eat / vegetables. Beef was found stored in thank you bags. These bags are not approved for direct contact food storage. 11 Several utensils were found dirty take more time when cleaning and sanitizing these items. 14 A large container of meat sauce cooked last night was found in the walk in cooler at 64 F. This item was not properly cooled. All food items being cooled for later service must be cooled from 135 F to 70 F with in the first two hours and from 70 F to 45 F over the next four hours for a total of six hours in the cooling process. This item was immediately discarded by the manager. 16 G.C. A small pot or refried beans was found in the grill at 110 F. This item was immediately reheated to 165 F by the manager. All food items being held hot must be held at or above 135 F. Spell check complete

4 N.C. Department of Environment and Natural Resourses Name: ID: Street: City: 2104 OLD LEXINGTON ROAD WINSTON SALEM 19 A spray bottle containing a purple liquid with no label found on a shelf. Properly label all chemicals to prevent cross contamination. 23 A large container of meat sauce was found in the cooling process in the walk in cooler with a tight fitting cover. This is not an approved cooling method. Use the following approved cooling methods: (1) placing the food in shallow pans; (2) separating the food into smaller or thinner portions; (3) using rapid cooling equipment; (4) stirring the food in a container placed in an ice water bath; (5) using containers that facilitate heat transfer; (6) adding ice as an ingredient; or (7) other effective methods. 25 The thermometer provided for checking food temperatures was not working properly. A metal stem-type thermometer accurate to 2 F (1 C) shall be available to check food temperatures. 26 Several bags of dry foods and a box of rice were found open in the stock room. Once the original packaging has been opened place all dry foods in approved closeable containers with labels. 28 Rodent droppings were found on several shelves in the dry goods storage room. Contact a pest control operator. 33 Bowls and other utensils with no handles were found in large containers of dry food items. Store all utensils in a manner that prevents contamination either in the product with the handle extending out of the product or on a clean dry surface. 34 Utensils were found stored in dirty bins. Place the storage bins on a regular cleaning schedule. Spell check complete

5 N.C. Department of Environment and Natural Resourses Name: ID: Street: City: 2104 OLD LEXINGTON ROAD WINSTON SALEM 36 Repair the condensation leak in the reach in freezer. No evidence of food contamination was found today, but as condensation is considered wastewater do not store food items below the damaged areas until the leaks are repaired. Repair or replace the shelving in the walk in cooler that is chipped and the lower shelves of the prep tables that are rusting. Repair the leaks found at the faucet of the 3 compartment sink and below the hand sink in the dish area. Remove the unapproved braces from the legs of the prep sinks. Repair the holes in the walk in cooler door. 39 Remove both blenders and the mixer as they are labeled for house hold use only and are not approved fro use in this facility. The hooks the pans are stored on are not approved as they are not easily cleanable. 40 Cleaning is needed on: the shelving, the interior and door gaskets of the refrigeration units, and the area below the grill. 43 Reattach the FRP to the walls in the men's restroom. Repair the water damaged ceiling tiles in the men's restroom. Repair the damaged baseboards in the men's restroom. Cleaning is needed on the fixtures of the men's restroom. Repair the holes in the men's restroom door. 45 Replace the cracked or damaged floor tiles throughout the facility. Repair and reseal the small holes and cracks found in the walls throughout the facility. Repair and seal the gaps in the baseboards throughout the facility. 46 G.C. Replace the non working light bulbs in above the ice machine and from service area. 48 G.C. Repair the broken self closure device on the rear door. All doors must be self closing. Performing spell check on field: inkv21

6 N.C. Department of Environment and Natural Resourses Name: ID: Street: City: 2104 OLD LEXINGTON ROAD WINSTON SALEM GC The grade card must remain posted in it's original location at all times. TEMPERATURE OBSERVATIONS Item Temp Item Temp Item Temp Performing spell check on field: inkgc1

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