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SA NUJ OAHU I N Environmental Health Department <br /> ■ COUNT Y-- <br /> c/ `p Greorne5S grows hey,. Time In: 12.00 pm <br /> Time Out: 1:30 om <br /> Food Program Official Inspection Report <br /> Name of Facility: WAGNER HEIGHTS NURSING& REHAB CTR Date: 05/01/2019 <br /> Address: 9289 BRANSTETTER PL, STOCKTON 95209 <br /> Owner/Operator: WAGNER HEIGHTS CONV HOSPITAL Telephone: (209)477-5252 <br /> Program Element: 1628-LICENSED HEALTH CARE FACILITY <br /> Inspection Type: ROUTINE INSPECTION -Operating Permit <br /> VIOLATIONS AND CORRECTIVE ACTIONS <br /> Items listed on this report as violations do not meet the requirements set forth in the California Health and Safety Code commencing with section 7; <br /> 113700.All violations must be corrected within specified timeframe. Violations that are classified as"MAJOR"pose an immediate threat to public health <br /> and have the potential to cause foodborne illness.All major violations must be corrected immediately.Non-compliance may warrant immediate closure of <br /> the food facility. <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:The right side water faucet bottom at the 3 comp sink is loose. Fix in 3 days. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as required <br /> by applicable plumbing codes. (114192)All plumbing and plumbing fixtures shall be installed in compliance with local plumbing <br /> ordinances, shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good repair. Any hose <br /> used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other purpose. (114171, <br /> 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Christine Anderson Expiration Date:October 12,2022 <br /> Warewash Chlorine(Cl): 100 ppm Heat: °F Water/Hot Water Ware Sink Temp: 133°F <br /> Quaternary Ammonia(QA): 200 ppm Hand Sink Temp: 107°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Mop sink-- 120.00°F Rice--Warmer--149.00°F <br /> Hand sink--Rest room--105.00°F Chicken vegetable soup--187.00°F <br /> Walk in cooler--40.00°F Puree 178.00°F <br /> Cooked chicken--Warmer--176.00°F Gravy--Warmer--156.00°F <br /> Corn--159.00°F 2 comp sink--125.00°F <br /> Stirr fry--Warmer--154.00°F <br /> NOTES <br /> Sanitizer bucket is set up with QUAT 200ppm. <br /> QUAT test strips are available. <br /> All potentially hazardous food on warmer is 135F or above. <br /> No major violations observed. <br /> FA0002878 PR0527315 SCO01 05/01/2019 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 2 Food Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />