GEORGIA DEPARTMENT OF PUBLIC HEALTH
Food Service Establishment Inspection Report
Establishment Name:  Xi An Gourmet House
Address:  955 Spring ST NW
City:  ATLANTA Time In:  03 :  25 PM Time Out:  04 :  50 PM
Inspection Date:    02/16/2024   CFSM:   Xianlong Xia
Purpose of Inspection:    Routine    Followup    Initial   
     Issued Provisional Permit    Temporary     
Risk Type:   1   2   3 Permit#:  FSP-060-010274
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

84
Grade

B
Date

12/01/22
Prior Score

100
Grade

A
Date

02/28/22
CURRENT SCORE CURRENT GRADE
 
66
  
U
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)   Beita Tang Date:    
Inspector (Signature)  
Follow-up: YES circle   NO circle
Follow-up Date:
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
Xi An Gourmet House		 Permit #
FSP-060-010274		 Date
02/16/2024
Address
955 SPRING ST NW 		City/State
ATLANTA GA		 Zipcode
30309
TEMPERATURE OBSERVATIONS
Item/Location Temp Item/Location Temp Item/Location Temp
Cold Holding, Main Kitchen, Cooler, , Beef 34.0 ° F Hot Holding, Main Kitchen, Steam Table, , Beef 152.0 ° F Hot Holding, Main Kitchen, Steam Table, , Beef strip soup 141.0 ° F
Hot Holding, Main Kitchen, Steam Table, , Tomato soup 135.0 ° F Cold Holding, Main Kitchen, Prep Top Cooler, , Tofu 40.0 ° F Cold Holding, Main Kitchen, Prep Top Cooler, , Tofu 38.0 ° F
Cold Holding, Main Kitchen, Prep Top Cooler, , Shredded cucumbers 41.0 ° F Cold Holding, Main Kitchen, Prep Top Cooler, , Sprouts 38.0 ° F    
Item
Number		 OBSERVATIONS AND CORRECTIVE ACTIONS
1-2A Violation of Code: [511-6-1.03(1)(a)-(c)1,4,5,6-14,15, 16] Facility failed to comply and maintain no priority items. Demonstration of Knowledge. Based on the risk of foodborne illness inherent to the food service operation, during inspections and upon request, the person in charge shall demonstrate to the Health Authority knowledge of foodborne disease prevention, application of the Hazard Analysis Critical Control Point principles, and the requirements of this Chapter. The person in charge shall demonstrate this knowledge in one of the following ways:

(a) Compliance with Chapter. Complying with this Chapter by having no violations of Priority Items during the current inspection; Pf

(b) Certified Food Service Manager. Being a certified food service manager who has shown proficiency of required information through passing a test that is part of an accredited program; Pf or

(c) Correct Answers to Food Safety Questions. Responding correctly to the inspector's questions as they relate to the specific food operation.  New Violation.
2-2D Violation of Code: [511-6-1.06(2)(o)] During routine inspection observed hand washing sink with metal pan and trash can blocking sink. Hand washing sinks shall be accessible at all times. Advised management to ensure employees are not using hand washing sink other than washing hands. COS manger removed metal pan and trash can.  New Violation.
2-2E Violation of Code: [511-6-1.03(6)] Facility failed to provided proper documentation or kit in an event of vomiting or diarrhea. Responding To Contamination Events. A food establishment shall have procedures for employees to follow when responding to vomiting or diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the food service establishment. The procedures shall address the specific actions employees must take to minimize the spread of contamination and the exposure of employees, consumers, food, and surfaces to vomitus or fecal matter. Pf  New Violation.
4-1A Violation of Code: [511-6-1.04(4)(c)1(i)(ii)(iii)(v)(vi)(vii)(viii)] Observed raw shell eggs stored over cooked beef. Food shall be protected from cross contamination by:

(i) Except as specified in paragraph (i)(III) of this subsection, separating raw animal foods during storage, preparation, holding, and display from:

(I) Raw ready-to-eat food including other raw animal food such as fish for sushi or molluscan shellfish, or other raw ready-to-eat food such as fruits and vegetables, P and

(II) Cooked ready-to-eat food; and P

(III) Frozen, commercially processed and packaged raw animal food may be stored or displayed with or above frozen, commercially processed and packaged, ready-to-eat food.

(ii) Except when combined as ingredients, separating types of raw animal foods from each other such as beef, fish, lamb, pork, and poultry during storage, preparation, holding, and display by:

(I) Using separate equipment for each type, P or

(II) Arranging each type of food in equipment so that cross contamination of one type with another is prevented, P and

(III) Preparing each type of food at different times or in separate areas; P

(iii) Cleaning and sanitizing equipment and utensils;  New Violation.
8-2B Violation of Code: [511-6-1.07(6)(c)] During routine inspection observed chemical glue stored on prep table above food. Storage, Separation. Poisonous or toxic materials shall be stored so they cannot contaminate food, equipment, utensils, linens, and single-service and single-use articles by: Separating the poisonous or toxic materials by spacing or partitioning. Advised manager to arrange facility to store chemicals below and away. Cos manager removed glue.  Corrected On-Site.  New Violation.
Person in Charge (Signature)    Date:  
Inspector (Signature) Tenesha Derricott Date: 02/16/2024
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
Xi An Gourmet House		 Permit #
FSP-060-010274		 Date
02/16/2024
Address
955 SPRING ST NW 		City/State
ATLANTA GA		 Zipcode
30309
Item
Number		 OBSERVATIONS AND CORRECTIVE ACTIONS
10D Violation of Code: [511-6-1.04(4)(d)] Observed containers of sauces and spray bottles not properly labeled to identify food product. Food Storage Containers, Identified with Common Name of Food. Except for containers holding food that can be readily and unmistakably recognized, such as dry pasta, working containers holding food or food ingredients that are removed from their original packages for use in the food establishment, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be clearly and legibly identified, in English, with the common name of the food. Advised manager to ensure all food items are properly labeled.  New Violation.
11A Violation of Code: [511-6-1.04(6)(e)] During routine inspection observed several metal pans of beef stored on shelving improperly cooling. Cooling shall be accomplished in accordance with the time and temperature criteria specified under DPH Rule 511-6-1-.04(6)(d) by using one or more of the following methods depending on the type of food being cooled: Using rapid cooling equipment.  New Violation.
12A Violation of Code: [511-6-1.04(4)(r)] During routine inspection observed raw beef being actively prepped onto of trash container. Advised manager to use prep-table. COS: manager place raw beef in meat sink.  Corrected On-Site.  Repeat Violation.
13A Violation of Code: [511-6-1.02(1)(d)] Observed incorrect inspection posted in public view. The most current inspection report shall be prominently displayed in public view at all times, within fifteen feet of the front or primary public door and between five feet and seven feet from the floor and in an area where it can be read at a distance of one foot away.  New Violation.
15C Violation of Code: [511-6-1.05(7)(a)2,3] During routine inspection observed equipment heavily soiled with old food debris and encrusted grease. The food-contact surfaces of cooking equipment and pans shall be kept free of encrusted grease deposits and other soil accumulations.  Repeat Violation.
Remarks
Person in Charge (Signature)    Date:  
Inspector (Signature) Tenesha Derricott Date: 02/16/2024
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