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STATE OF HAWAII FOOD ESTABLISHMENT INSPECTION REPORT Page _1_ of 2

Establishment Name Date: 11/27/2018
Time In: 03:40 PM
KILOHANA UNITED METHODIST CHURCH PRESCHOOL, INC Time Out: 04:45 PM
Address City Zip Code Telephone
5829 MAHIMAHI ST HONOLULU 96821
Permit # Owner Name Purpose of Inspection Est. Type Risk Category
39. SERVICE AREA -
008513 KILOHANA UNITED METHODIST CHURCH General Complaint LIMITED FOOD PREP - 3 3
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item: Mark “X” in appropriate box for:
IN=in compliance OUT=not in compliance N/O=not observed N/A=not applicable COS=corrected on-site during inspection and/or R=repeat violation
Compliance Status COS R Compliance Status COS R

Supervision Potentially Hazardous Food (TCS food)
1 IN OUT Person in charge present, demonstrates 16 IN OUT N/A N/O Proper cooking time and temperatures
knowledge, and performs duties 17 IN OUT N/A N/O Proper reheating procedures for hot holding
Employee Health 18 IN OUT N/A N/O Proper cooling time and temperatures
2 IN OUT Management awareness; policy present 19 IN OUT N/A N/O Proper hot holding temperatures
3 IN OUT Proper use of reporting, restriction & exclusion 20 IN OUT N/A Proper cold holding temperatures
Good Hygienic Practices 21 IN OUT N/A N/O Proper date marking and disposition
4 IN OUT N/O Proper eating, tasting, drinking, or tobacco use 22 IN OUT N/A N/O Time as a public health control: procedures
5 IN OUT N/O No discharge from eyes, nose, and mouth & records

Preventing Contamination by Hands Consumer Advisory
6 IN OUT N/O Hands clean and properly washed 23 IN OUT N/A Consumer advisory provided for raw or
7 IN OUT N/A N/O No bare hand contact with ready-to-eat foods undercooked foods
or approved alternate method properly Highly Susceptible Populations
followed
8 IN OUT Adequate handwashing facilities supplied 24 IN OUT N/A Pasteurized foods used; prohibited foods not
and accessible offered
Approved Source Chemical
9 IN OUT Food obtained from approved source 25 IN OUT N/A Food additives: approved and properly used
10 IN OUT N/A N/O Food received at proper temperature 26 IN OUT Toxic substances properly identified, stored,
and used
11 IN OUT Food in good condition, safe, and
unadulterated Conformance with Approved Procedures
12 IN OUT N/A N/O Required records available: shellstock tags, 27 IN OUT N/A Compliance with variance, specialized process,
parasite destruction and HACCP plan
Protection from Contamination
13 IN OUT N/A Food separated and protected Risk factors are food preparation practices and employees behaviors most
commonly reported to the Centers for Disease Control and Prevention as
14 IN OUT N/A Food-contact surfaces: cleaned and sanitized
contributing factors in foodborne illness outbreaks.
15 IN OUT Proper disposition of returned, previously Public health interventions are control measures to prevent foodborne
served, reconditioned, and unsafe food illness or injury.
GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the introduction 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 = corrected on-site during inspection and/or R = repeat violation
Safe Food and Water COS R Proper Use of Utensils COS R
28 Pasteurized eggs used where required 41 In-use utensils: properly stored
29 Water and ice from approved source 42 Utensils, equipment and linens: properly stored, dried, handled
30 Variance obtained for specialized processing methods 43 Single-use/single-service articles: properly stored, used
Food Temperature Control 44 Gloves used properly
31 Proper cooling methods used: adequate equipment for Utensils, Equipment and Vending
temperature control
45 Food and nonfood-contact surfaces cleanable, properly
32 Plant food properly cooked for hot holding designed, constructed, and used
33 Approved thawing methods used 46 Warewashing facilities: installed, maintained, used; test strips
34 Thermometers provided and accurate 47 Nonfood-contact surfaces clean
Food Identification Physical Facilities
35 Food properly labeled; original container 48 Hot and cold water available; adequate pressure
Prevention of Food Contamination 49 Plumbing installed; proper backflow devices
36 Insects, rodents, and animals not present 50 Sewage and waste water properly disposed
37 Contamination prevented during food preparation, storage, 51 Toilet facilities: properly constructed, supplied, clean
and display
38 Personal cleanliness 52 Garbage/refuse properly disposed; facilities maintained
39 Wiping cloths: properly used and stored 53 Physical facilities installed, maintained, and clean
40 Washing fruits and vegetables 54 Adequate ventilation and lighting; designated areas used
Print and Signature of Person in Charge: Date:
11/27/2018
Signature of Agent/Dept. of Health: Follow-up: (Circle one) YES
ONO Follow-up Date:

SAN INSP FOOD 01/16
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STATE OF HAWAII
DEPARTMENT OF HEALTH

FOOD ESTABLISHMENT INSPECTION REPORT - SUPPLEMENT

EST. NAME KILOHANA UNITED METHODIST CHURCH PRESCHOOL, INC
PERMIT NO. 008513 DATE
11/27/2018

REMARKS

Complaint Inspection:

On 11/27/18, preschool director notified parent that child was served pine-sol "accidentally" mistaken for apple juice because it was the same color.

Findings:

Spoke to the director about the complaint and events leading up to the incidence. She stated the morning snacks were being prepared by the classroom assistant in

the kitchen. The snacks consisted of dry crackers and juice. The assistant saw the yellow/brown colored liquid container on a clean-up cart in the kitchen and

returned to the classroom with the crackers and container with liquid. The assistant poured the liquid into cups as the classroom teacher oversaw the students at

the restroom. The classroom teacher smelled that it was not apple juice and stopped the students from drinking it. The liquid was in the original Pine-Sol

container and proper labeled. The cart has no food items on or in it, a rubbish can and cleaning supplies are stored on this cart. The cleaning supplies are

stored below the kitchen sink and in the janitors room. All the food items in the kitchen are properly stored and labeled in the kitchen cabinets.

See attached pictures

No violation noted under Chapter 50, Food Safety Code

SIGNATURE OF PERSON IN CHARGE SIGNATURE OF AGENT/DEPT. OF HEALTH

SAN INSP SUP FOOD 01/16 COPY TO ESTABLISHMENT SU CL