Food Establishment Inspection Report
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OFFICE OF ENVIRONMENTAL SERVICES
21306 Illinois Route 9
Tremont, IL 61568-9252
Establishment
PEKIN MANOR/LIBERTY VILLAGE 		License/Permit #
434
Street Address
1520 EL CAMINO DR
City/State
PEKIN, IL 		ZIP Code
61554
No. of Risk Factor/Intervention Violations 1
No. of Repeat Risk Factor/Intervention Violations 0
Date 04/04/2024
Time In 10:00 AM
Time Out 11:15 AM
Permit Holder
PEKIN MANOR/LIBERTY VILLAGE 		Risk Category
Category I
Purpose of Inspection   Regular

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item
IN=in compliance    OUT=not in compliance    N/O=not observed    N/A=not applicable
Mark "X" in appropriate box for COS and/or R
COS=corrected on-site during inspection    R=repeat violation 		Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury.
Compliance Status
 COS R

SUPERVISION

 
1 IN OUT     Person in charge present, demonstrates knowledge, and performs duties    
2 IN OUT N/A   Certified Food Protection Manager    

EMPLOYEE HEALTH

 
3 IN OUT     Management, food employee and conditional employee; knowledge, responsibilities and reporting    
4 IN OUT     Proper use of restriction and exclusion    
5 IN OUT     Procedures for responding to vomiting and diarrheal events    

GOOD HYGIENIC PRACTICES

 
6 IN OUT   N/O Proper eating, tasting, drinking, or tobacco use    
7 IN OUT   N/O No discharge from eyes, nose, and mouth    

PREVENTING CONTAMINATION BY HANDS

 
8 IN OUT   N/O Hands clean & properly washed    
9 IN OUT N/A N/O No bare hand contact with RTE food or a pre-approved alternative procedure properly allowed    
10 IN OUT     Adequate handwashing sinks properly supplied and accessible    

APPROVED SOURCE

 
11 IN OUT     Food obtained from approved source    
12 IN OUT N/A N/O Food received at proper temperature    
13 IN OUT     Food in good condition, safe, & unadulterated    
14 IN OUT N/A N/O Required records available: shellstock tags, parasite destruction    
 
Compliance Status
 COS R

PROTECTION FROM CONTAMINATION

 
15 IN OUT N/A N/O Food separated and protected    
16 IN OUT N/A   Food-contact surfaces: cleaned & sanitized X  
17 IN OUT     Proper disposition of returned, previously served, reconditioned & unsafe food    

TIME/TEMPERATURE CONTROL FOR SAFETY

 
18 IN OUT N/A N/O Proper cooking time & temperatures    
19 IN OUT N/A N/O Proper reheating procedures for hot holding    
20 IN OUT N/A N/O Proper cooling time and temperature    
21 IN OUT N/A N/O Proper hot holding temperatures    
22 IN OUT N/A N/O Proper cold holding temperatures    
23 IN OUT N/A N/O Proper date marking and disposition    
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records    

CONSUMER ADVISORY

 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food    

HIGHLY SUSCEPTIBLE POPULATIONS

 
26 IN OUT N/A   Pasteurized foods used; prohibited foods not offered    

FOOD/COLOR ADDITIVES AND TOXIC SUBSTANCES

 
27 IN OUT N/A   Food additives: approved and properly used    
28 IN OUT N/A   Toxic substances properly identified, stored, & used    

CONFORMANCE WITH APPROVED PROCEDURES

 
29 IN OUT N/A   Compliance with variance/specialized process/HACCP    

GOOD RETAIL PRACTICES
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  
  COS R

SAFE FOOD AND WATER

 
30   Pasteurized eggs used where required    
31   Water & ice from approved source    
32   Variance obtained for specialized processing methods    

FOOD TEMPERATURE CONTROL

 
33   Proper cooling methods used; adequate equipment for temperature control    
34   Plant food properly cooked for hot holding    
35   Approved thawing methods used    
36   Thermometers provided & accurate    

FOOD IDENTIFICATION

 
37   Food properly labeled; original container    

PREVENTION OF FOOD CONTAMINATION

 
38   Insects, rodents, & animals not present    
39   Contamination prevented during food preparation, storage & display    
40   Personal cleanliness    
41   Wiping cloths: properly used & stored    
42   Washing fruits & vegetables    

PROPER USE OF UTENSILS

 
43   In-use utensils: properly stored    
 
  COS R

PROPER USE OF UTENSILS

 
44   Utensils, equipment & linens: properly stored, dried, & handled    
45   Single-use/single-service articles: properly stored & used    
46   Gloves used properly    

UTENSILS, EQUIPMENT, AND VENDING

 
47   Food & non-food contact surfaces cleanable, properly designed, constructed & used    
48   Warewashing facilities: installed, maintained & used; test strips    
49   Non-food contact surfaces clean    

PHYSICAL FACILITIES

 
50   Hot & cold water available; adequate pressure    
51   Plumbing installed; proper backflow devices    
52   Sewage & waste water properly disposed    
53   Toilet facilities: properly constructed, supplied, & cleaned    
54   Garbage & refuse properly disposed; facilities maintained    
55 X Physical facilities installed, maintained & clean    
56   Adequate ventilation & lighting; designated areas used    

EMPLOYEE TRAINING

 
57   All food employees have food handler training    

ALLERGEN AWARENESS & TRAINING

 
58   Allergen awareness and training    
IOCI 17-356

Food Establishment Inspection Report
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Establishments: PEKIN MANOR/LIBERTY VILLAGE Establishment #: 434
Water Supply:   Public Private   Waste Water System:   Public Private
Temperature Documentation: NO License Posted: NO Complaint Number:
Sanitation Information
Name: KAYLA HULIN    
Name: TRISHA CLEWELL    
Name: SALOME BELL    
Name: LOAN DUONG    
Name: NICOLE RENNIE    
Name: MARJORIE STEWART    
Name: STEPHANIE OGLE    
Name: PAMELA MOODY    

SANITIZER OBSERVATIONS
Location Location Desc. Method Used Chemical Sanitizer Used PPM Water Temp
Sanitizer Bucket Bakery area Chemical Sanitizer Quaternary Ammonium 50.00 0.00
Sanitizer Bucket Bakery Area Chemical Sanitizer Quaternary Ammonium 200.00 0.00
Dish Machine Dishwashing area Hot Water   0.00 160.00

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
air temp/Freezer 1 10.00°F air temp/freezer 2 4.00°F air temp/Milk Cooler 35.00°F
air temp/walk-in cooler 37.00°F deli meat/walk-in cooler 37.00°F air temp/walk-in freezer 5.00°F
air temp/two-door cooler 39.00°F Cheese/two-door cooler 41.00°F air temp/service cooler 38.00°F
Chicken/hot holding 155.00°F    

OBSERVATIONS AND CORRECTIVE ACTIONS
Item
Number 		Violations cited in this report must be corrected within the time frames below.
16 ****

Bucket of Quat sanitizer tested at 50 ppm. COS, person in charge dumped bucket and made new sanitizer that tested at 200 ppm. Please ensure that buckets are changed regularly to maintain proper concentration.

- 4-501.114 (C): (C) A chemical SANITIZER used in a SANITIZING solution for a manual or mechanical operation at contact times specified under ¶4-703.11(C) shall meet the criteria specified under §7-204.11 Sanitizers, Criteria, shall be used in accordance with the EPA- registered label use instructions, and shall be used as follows: (C) A quaternary ammonium compound solution shall: (1) Have a minimum temperature of 24°C (75°F), (2) Have a concentration as specified under § 7-204.11 and as indicated by the manufacturer's use directions included in the labeling, and (3) Be used only in water with 500 MG/L hardness or less or in water having a hardness no greater than specified by the EPA-registered label use instructions. - V,COS
55 ****

The floor in the walk-in freezer is buckling and the floor tile next to the stove is chipped. Please ensure that these areas are maintained and in good repair.

****

- 6-501.11: PHYSICAL FACILITIES shall be maintained in good repair. - V
Inspection Comments Facility had just received a shipment and some cans were temporarily stored on the floor in their packaging. PIC is putting shipment away.
HACCP Topic: Discussed correct sanitizer concentration
 

Person In Charge (Signature)

  Deborah Hagemeier 		 

Date:

  04/04/2024
 

Inspector

  ELLIOT LUSK 		 

Follow-up:  Yes   No   Follow-up Date: