GEORGIA DEPARTMENT OF PUBLIC HEALTH
Food Service Establishment Inspection Report
Establishment Name:  Forest Heights Country Club
Address:  3772 Country Club RD
City:  Statesboro Time In:  02 :  55 PM Time Out:  04 :  45 PM
Inspection Date:    06/27/2023   CFSM:   Obtain immediately
Purpose of Inspection:    Routine    Followup    Initial   
     Issued Provisional Permit    Temporary     
Risk Type:   1   2   3 Permit#:  FSP-016-000200
Risk Factors are food preparation practices and employee behaviors most commonly reported to the Centers for Disease Control and Prevention as contributing factors in foodborne illness outbreaks. Public Health Interventions are control measures to prevent illness or injury. Good Retail Practices are preventive measures to control the introduction of pathogens, chemicals, and physical objects into foods.
Last Score

92
Grade

A
Date

12/14/22
Prior Score

77
Grade

C
Date

12/09/22
CURRENT SCORE CURRENT GRADE
 
74
  
C
SCORING AND GRADING:     A=90-100    B=80-89    C=70-79    U≤69

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
(Mark designated compliance staus (IN, OUT, NA, or NO) for each numbered item. For items marked OUT, mark COS or R for each item as applicable.)

IN=in compliance    OUT=not in compliance    NO=not observed    NA=not applicable    COS=corrected on-site during inspection      R=repeat violation of the same code provision=2 points
Compliance Status COS R
1 IN OUT NA NO Supervision 4 points
  circle circle     1-2A. PIC present, demonstrates knowledge, performs duties circle circle
  circle circle circle   1-2B. Certified Food Protection Manager circle circle
2 IN OUT NA NO Employee Health, Good Hygienic Practices, Preventing Contamination by Hands 9 points
  circle circle     2-1A. Proper use of restriction & exclusion circle circle
  circle circle   circle 2-1B. Hands clean and properly washed circle circle
  circle circle circle circle 2-1C. No bare hand contact with ready-to-eat foods or approved alternate method properly followed circle circle
  4 points
  circle circle     2-2A. Management knowledge, responsibilities, reporting circle circle
  circle circle   circle 2-2B. Proper eating, tasting, drinking, or tobacco use circle circle
  circle circle   circle 2-2C. No discharge from eyes, nose, and mouth circle circle
  circle circle     2-2D. Adequate handwashing facilities supplied & accessible circle circle
  circle circle     2-2E. Response procedures for vomiting & diarrheal events circle circle
3 IN OUT NA NO Approved Source 9 points
  circle circle     3-1A. Food obtained from approved source circle circle
  circle circle circle circle 3-1B. Food received at proper temperature circle circle
  circle circle     3-1C. Food in good condition, safe, and unadulterated circle circle
  circle circle circle circle 3-1D. Required records: shellstock tags, parasite destruction circle circle
4 IN OUT NA NO Protection From Contamination 9 points
  circle circle circle circle 4-1A. Food separated and protected circle circle
  circle circle     4-1B. Proper disposition of returned, previously served, reconditioned, and unsafe food circle circle
  4 points
  circle circle circle   4-2A. Food stored covered circle circle
  circle circle circle   4-2B. Food-contact surfaces: cleaned & sanitized circle circle
 
Compliance Status COS R
5 IN OUT NA NO Cooking and Reheating of TCS Foods, Consumer Advisory 9 points
  circle circle circle circle 5-1A. Proper cooking time and temperatures circle circle
  circle circle circle circle 5-1B. Proper reheating procedures for hot holding circle circle
    4 points
  circle circle circle   5-2. Consumer advisory provided for raw and undercooked foods circle circle
6 IN OUT NA NO Holding of TCS Foods, Date Marking of TCS Foods 9 points
  circle circle circle circle 6-1A. Proper cold holding temperatures circle circle
  circle circle circle circle 6-1B. Proper hot holding temperatures circle circle
  circle circle circle circle 6-1C. Proper cooling time and temperature circle circle
  circle circle circle circle 6-1D. Time as a public health control: procedures and records circle circle
    4 points
  circle circle circle circle 6-2. Proper date marking and disposition circle circle
7 IN OUT NA NO Highly Susceptible Populations 9 points
  circle circle circle   7-1. Pasteurized foods used: Prohibited foods not offered circle circle
8 IN OUT NA NO Chemicals 4 points
  circle circle circle   8-2A. Food additives: approved and properly used circle circle
  circle circle     8-2B. Toxic substances properly identified, stored, used circle circle
9 IN OUT NA NO Conformance with Approved Procedures 4 points
  circle circle circle   9-2. Compliance with variance, specialized process and HACCP plan circle circle
GOOD RETAIL PRACTICES
(Mark the numbered item OUT, if not in compliance. For items marked OUT, mark COS or R for each item as applicable. R = Repeat Violation of the same code provision = 1 point)
Good Retail Practices are preventive measures to control the introduction of pathogens, chemicals, and physical objects into foods.
Compliance Status COS R
10 OUT Safe Food and Water, Food Identification 3 points
  circle 10A. Pasteurized eggs used where required circle circle
  circle 10B. Water and ice from approved source circle circle
  circle 10C. Variance obtained for specialized processing methods circle circle
  circle 10D. Food properly labeled; original container circle circle
11 OUT Food Temperature Control 3 points
  circle 11A. Proper cooling methods used: adequate equipment for temperature control circle circle
  circle 11B. Plant food properly cooked for hot holding circle circle
  circle 11C. Approved thawing methods used circle circle
  circle 11D. Thermometers provided and accurate circle circle
12 OUT Prevention of Food Contamination 3 points
  circle 12A. Contamination prevented during food preparation, storage, display circle circle
  circle 12B. Personal cleanliness circle circle
  circle 12C. Wiping cloths: properly used and stored circle circle
  circle 12D. Washing fruits and vegetables circle circle
13 OUT Postings and Compliance with Clean Air Act 1 point
  circle 13A. Posted: Permit/Inspection/Choking Poster/Handwashing circle circle
  circle 13B. Compliance with Georgia Smoke Free Air Act circle circle
 
Compliance Status COS R
14 OUT Proper Use of Utensils 1 point
  circle 14A. In-use utensils: properly stored circle circle
  circle 14B. Utensils, equipment and linens: properly stored, dried, handled circle circle
  circle 14C. Single-use/single-service articles: properly stored, used circle circle
  circle 14D. Gloves used properly circle circle
15 OUT Utensils, Equipment and Vending 1 point
  circle 15A. Food and nonfood-contact surfaces cleanable, properly designed, constructed, and used circle circle
  circle 15B. Warewashing facilities: installed, maintained, used; test strips circle circle
  circle 15C. Nonfood-contact surfaces clean circle circle
16 OUT Water, Plumbing and Waste 2 points
  circle 16A. Hot and cold water available; adequate pressure circle circle
  circle 16B. Plumbing installed; proper backflow devices circle circle
  circle 16C. Sewage and waste water properly disposed circle circle
17 OUT Physical Facilities 1 point
  circle 17A. Toilet facilities: properly constructed, supplied, cleaned circle circle
  circle 17B. Garbage/refuse properly disposed; facilities maintained circle circle
  circle 17C. Physical facilities installed, maintained, and clean circle circle
  circle 17D. Adequate ventilation and lighting; designated areas used circle circle
18 OUT Pest and Animal Control 3 points
  circle 18. Insects, rodents, and animals not present circle circle
Person in Charge (Signature)   (Print)   PIC Date:   06/27/2023
Inspector (Signature)  
Follow-up: YES circle   NO circle
Follow-up Date: 09/27/2023
Food Establishment Inspection Report Addendum
Violations cited in this report must be corrected within the time frames specified below, or as stated in the Georgia Department of Public Health Rules and Regulations Food Service Chapter 511-6-1, Rule .10 subsections (2)(h) and (i).
Establishment
Forest Heights Country Club		 Permit #
FSP-016-000200		 Date
06/27/2023
Address
3772 COUNTRY CLUB RD 		City/State
STATESBORO GA		 Zipcode
30458
TEMPERATURE OBSERVATIONS
Item/Location Temp Item/Location Temp Item/Location Temp
Cold Holding, Main Kitchen, Reach In Cooler, Cheese, 41.0 ° F Cold Holding, Main Kitchen, Reach In Cooler, Cut Leafy Greens, lettuce 41.0 ° F Just Cooked, Main Kitchen, Fryer, Chicken, chicken wings 189.0 ° F
Cold Holding, Main Kitchen, Walk in Cooler, Pork, cooked pork 39.0 ° F Cold Holding, Main Kitchen, Walk in Cooler, Beef, whole raw beef 41.0 ° F Cold Holding, Main Kitchen, Walk in Cooler, Cheese, shredded cheese 41.0 ° F
Cold Holding, Main Kitchen, Reach In Cooler, Fish/Seafood, raw fish 47.0 ° F Cold Holding, Main Kitchen, Reach In Cooler, Chicken, raw chicken 50.0 ° F    
Item
Number		 OBSERVATIONS AND CORRECTIVE ACTIONS
1-2B Violation of Code: [511-6-1.03(3)(a)] Observed no certified food protection manager for facility. CA: Food service establishments shall have in its employ a Certified Food Safety Manager (CFSM) as specified in paragraph (b) of this subsection to ensure food safety is being managed within the food service establishment during all hours of operation as specified within paragraph (d) of this subsection.  New Violation. Correct By: 07/07/2023
3-1C Violation of Code: [511-6-1.04(1)] Observed multiple moldy food items stored in reach in cooler. COS: PIC discard food items.  Corrected On-Site.  New Violation.
4-2B Violation of Code: [511-6-1.05(7)(a)1] Observed build up on ice baffle of ice machines and build up on the blade of can opener. CA: Equipment food-contact surfaces and utensils shall be clean to sight and touch.  New Violation. Correct By: 07/07/2023
6-1A Violation of Code: [511-6-1.04(6)(f)] Observed raw chicken and raw fish cold holding above 41F. COS: PIC discarded food items.  Corrected On-Site.  New Violation.
Remarks
Person in Charge (Signature)    Date: 06/27/2023
Inspector (Signature) Quentin Smith Date: 06/27/2023