STATE OF FLORIDA 0 5 | | / 5 6 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGQLATION DIVISION OF HOTELS AND RESTAURANTS»: .- DEPARTMENT OF BUSINESS AND wae vv dey am PROFESSIONAL REGULATION EM hat bo 1 | Petitioner, vs. A LA CAFE License No. 3905018 neti Respondent. License Type 2010 Permanent Food Service / Case No. 2004046609 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against LA CAFE, (“Respondent”), and says: 1. Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service establishments, pursuant to Section 20.165 and Chapter 509, Florida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 3405 W MARTIN LUTHER KING JR. BLVD, TAMPA, FLORIDA 33607.The mailing address of recerd is LA CAFE, at 201 CIRCLE DR N, BLDG # 112 , PISCATAWAY, NEW JERSEY 08854. 3. Inspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment. The violation(s) found and applicable law are described in Exhibit “A,” attached hereto and incorporated herein by reference. Inspection documents are attached as Exhibit “B’, incorporated herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine not to exceed $1,000 per offense; mandatory attendance at Respondent's expense at an educational program sponsored by the Department's Hospitality Education Program; suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promulgated thereto. Signed September 22, 2004 ia District Manager < - By dele§ation of the Director, or desigfiee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No. 0153831 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7160-3901-9848-5780-4923 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2004. Received by: _ inspector's Signature Operator's Signature Title Title 7 Case Number: 2004046609 Form revised 9/8/04 License Type: 2010 Permanent Food Service District Number: 03 License Number: 3905018 LA CAFE License Number: 3905018 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004046609 Exhibit A “EC" as cited herein references specific provisions of the 1999 Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Code. “NFPA” as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 4A-3, “Fire Prevertion, General Provisions”, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. It is alleged that on July 26, 2004, August 26, 2004 and September 16, 2004, the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Cade (FAC), in the following particulars. Copy(s) of the report(s) for the above referenced inspection/s) are attached hereto and incorporated by reference as Exhibit B. * 4.31-10 5-204.11 & 6-401.10 FC HANDWASHING FACILITY. CONVENIENTLY LOCATED. A HANDWASHING FACILITY SHALL BE LOCATED: (A) TO ALLOW CONVENIENT USE BY EMPLOYEES IN FOOD PREPARATION, FOOD DISPENSING, AND WAREWASHING AREAS; AND (B) IN, OR IMMEDIATELY ADJACENT TO, TOILET ROOMS. MISSING HANDSINK IN FOOD PREPARATOIN AREA. FRONT AREA WHERE SANDWICHES AND PIZZA ARE PREPARED. * denotes critical violation Exhibit A Case Number: 2004046609 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 3905018 LOA Ee AR EES PRBS AIL DEPARTMENT OF BUSINESS AND PRu Division of Hotels and Restaurants vn [cer Cem fur 9 fo PFI ir explanation of citations, y LICENSING File Number DISTRICT © cst 7 x OWNER NAME Catering = . Vendin: C A feo Steck pen 3 BUSINESS NAME MFDV _ Theme Park CA Cure | Food Cart Le ADDRESS i BS _ “Temporary ~ 3 veo 5 oe wmcic Bod | 1B c loping} Temp. Assot: cry (Optional w/Perm. Est @ BE . ~ ae 74 R3Ce? Bw BB No. of Seats BDBoogagag Be (© General @ Seating Pes as Be De eyo - INSPECTION TIME 3 INSPECTION REASON > In Out s2¢ : > i 18 i 1 #® Routine suspensia a | ool sl oes | ose 3 Complaint pens @ em By} BB Be 4 © Iniormation mB Oa | @ Bote | & wea 5 €3 Epidemiological 3 ANY VIOLATIONS noted ; corrected by the NEX i) | Be Si @ GB B GB DISPOSITION coe 4 B a)|e| oe Be 6 © Pending 2 WARNING i | Loe. Violations in the operation of y t @B ie) Be oe establisnment must be co! y { bir oe ae Bw Dat :— Time; aa 8 @ | Se Qe © HACCP INSPECTION by 3 | Bs Be i Et) g a Be o TH 8D se EE] &3 G3 BS Food Manager Naw: sy cor 14°} 2309 930G 423 “sof “atpt 3 ge 1575 24( 2 ae 51> 180 25(}-35e 42e 82 303 *33bE Dat S Sanitizing Concentration ppm es) a0 | Sanitizing Temperature degrees F. j 113 "20803 550) | oa 12a "20603 300) 390 a7 seg |COMMENTS SOO 205 31 4065 870 Cyan. Greek Ltn Z Coen es es ee 06C3 1323 2203 53 20 ma GOMMENTS ON ATTACHED COMMENT SHEET ! acknowledge receipt of this inspection form and comments. REMINDER: Your license expires /_»_._. ns Name (PLEASE PRINT) thect C Hevs $ ~ Reeip Fspector's Name (PLEASE PRINT: Ditenass fev eie gcc Reciprents Five Tule “Chek SESS _ Inspectors renaly “y 2 “db lle BTS 272-3263 Office Teicphone SO° YIVABT ce und Teme TE=OY id Fo ober DBPR Form HR 5022-015 DISTRICT OFFICE COPY www hospitalityeducation org Revised 2002 Octope: 7 State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants BG - 6 ster www. hospitalityeducation.org COMMENTS SHEET Page__2-of_2 Addendum to DBPR Forms HR 5022-005, 5022-014, 5022-015, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP Inspection; Call Back/Reinspection Report, or HACCP Plan Verification. Control Number WieluTicm peT Cenave rg ! ‘oO 5 oa > % - ey _S { “fo ~ O OS prog Pe Sfp b- ftedne Syne tame Bees Fat y . . - . a ae . PeenT pete Crk Synge es + P1224 fat Jr Sergeants Aan f j : 7 i: OBPR Form HR 5022-042 MyFlorida.com 2001 November 01 a eo f LEGAL NOTICE DEPARTMENT .OF BUSINESS AND PRurESSIONAL REGULATION S& Division of Hotels and Restaurants fs FOOD SERVICE INSPECTION REPORT LICENSING pistrict © Bae ; [OWNER NAME © Catering 2 “4 (3 Vending = ina Het Se BVVeVB.assg] 2B BUSINESS NAME (3 MFDV BBA0veagaas ) Theme Park bs Food Cart BEa@Seo es 934 ES BESE30 3) . © Temporary : Axa Z 3 Temp. Assoc. B a Ow BB ss) BB: cy ZIP (Opnanal) a Alls se BOWBAga aq BB ran a ~ oe - Lf OF i SoS @BGBoegg Be © General * 8 Seating “Fe Os oaan BB “= INSPECTION DATE INSPECTION REASON ; Failure to comply with this Notice may initiate an 1 ® - Routine administrative complaint that ‘may result in suspension or revocation of your. 3 £3. Complaint’. and fines. 4 (information INSPECTION RESULTS 5.£3. Epidemiological DISPOSITION 4 3“ ANY VIOLATIONS noted herein must be” :Gor-ected by thé NEXT ROUTINE INSPECTION. 6 ©3° Pending 2 8. WARNING: beim Violations in the operatioT ct YOUR establishment must be corrected by. i) HACCP INSPECTION 3 @3. ADMINISTRATIVE COMPLAINT recommended,’ 5 (3). Seasonal er ee [eve ee 6 (3° EMERGENCY ORDER recommended based upon a severe and immediate threat to the pub! “ATEN 203:'FOOD TEMPERATURES: ircled tetriperatures are in violatio: NOTE: ITEMS IN RED AND MARKED WITH : ‘AN ASTERISK ARE OF CRITICAL CONCERN pemgpagy ae AND MUST BE CORRECTED IMMEDIATELY.” gama ee ame See revérse side for explanation of citations: 7 soray 073 1403-3363 99} ata} 5063. = ae | | - - = — “01DE3 08a 1563 2409-340 1 woe eee . | 02} 0a 1809 2809 +35a} EQ 2 : . - CIRCLED ITEMS ARE IN VIOLATION aga one 173. 26 "38. aC "6393 WAREWASHING SANITIZATION ; *03bf) . 0903. .18}. 2709-3609 44 520s: ; . Date(s) . i Sanitizing Concentration ppm > *03¢ (3: 10 190} “2803 378 “4503 5403 "03003 “11320aC}. 2909 69 46 55 +043 12a *20bC3 "3003 396) “4709 56 COMMENTS 0509100 210 10) 0 “8 870 Px MB Bao 6 im) 2203 324 mm: 58C) FP Bwt - é z wr gta os sete: OS ° ADDITIONAL GOMMENTS ON ATTACHED COMMENT SHE! . : / a | acknowledge receipt of this inspection form and comments. REMINDER: Your license expires————'__ ss Inspector's Name (PLEASE PRINT} Sanitizing Temperature _________. degrees F. Inspecior’s Signaue Bice Telephone Date ~ | # Establishment Tetephone State of Florida Control Number Department of Business and Professional Regulation Division of Hotels and Restaurants nie eee www. hospitalityeducation.org COMMENTS SHEET = = ss P#se_2.of_2_ Addendum to DBPR Forms HR 5022-005, 5022-014, 5022-015, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP Inspection; Call Back/Reinspection Report, or HACCP Plan Verification. DBPR FormHR 5022-042 tAyFlorida.com 2C01 November 01 Page 1 of 8 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. 7/26/04 11:28:54 AM Routine 3905018 SEAT inspection Date and Time inspection Reason License Number LA FOOD SERVICE INC WARNING: Owner Name Violations in the operation of your 3767 LA CAFE establishment must be corrected by: Area Code/Telephone Number Business Name Inspection Result 30 08/26/2004 08:00 AM 02/010 Number of Units Callback Date/Time License Expiration 3405 W_MLK BLVD TAMPA FL. 33607 Address / City / State / Zip / etc. Item 03: Food Temperatures Item 53a: Cert. Food Managers [tem 20: Warewashing Sanitization | Item 45: Fire Extinguishers and Fire Suppression Systems Dates ___ Ham, prep area, 38 Degrees F. Manager Name: robert c hovis Certification Date: A Class BC type Fire Extinguisher, found in/at Pasta salad, buffet, cold, 42 Degrees F. 02/26/03 Certified by: National Reg'stry of Food kitzhen has a certification date of 02/04 12 Roast beef, prep area, 40 Degraes F. Safety Professionals Spaggetti Sauce, potentially hazardous, buffet, hot holding, 174 Degvees F. NOTE: Items marked above with an asterisk (*} indicate a violation Inspector's Comments Water Source: Municipal/Utility. Sewage: Municipal/Utility. | acknowledge receipt of this inspection form and comments. Aigo se LO. 07/26/04 12:32 PM Date/Time Signature of Recipient __Inspector Signature Recipient: robert c hovis For further information please contact: 7 F. Dennis Mirabetta Title chef Senior Sanitation Safety Specialist 3725 W Grace S:reet Tampa, Fi Phone; 878-3767 2804871385 STATUS SOURCE STATUS PHF TEMPERATURE CONTROL Yes *O1a Approved source Yes *03b Hot food at proper temperature . Yes *01b Wholesome, sound condition Yes “03c Foods properly cooked/reheated Yes 02 Original container; property labeled, date marking Yes *03d Foods properly cooled STATUS PHF TEMPERATURE CONTROL Yes *04 Facilities to maintain product temperature Yes *03a Cold food at proper temperatures during storage, Yes 05 Thermometers provided and conspicuously placed i display, service, transport, and cold holding Yes 06 Potentially hazardous foods properly thawed Violations marked with an asterisk are critical violations. Items marked YES are in compliance. Items Marked NO are violations. Specific details of violation are listed on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/O are Not Observed, arid were nat being conducted D&PR FORM HR 5022-014 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Page 2 of 8 License Number SEAT 3905018 Inspection Date 7/26/04 11:28:54 AM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. 1, Wash 2. Rinse 3. Sanitize No 17 Thermometers, gauges, test kits provided Yes STATUS No STATUS PHF TEMPERATURE CONTROL il STATUS | GARBAGE AND REFUSE DISPOSAL Yes "07 Unwrapped or potentially hazardous food not re-served jYes 33 Containers covered, adequate number, ‘rsect and rodent No *08a Food protection during storage, preparation, display, roof, emptied at proper intervals, clean service, transportation Yes 134 Outside storage area clean, enclosure properly Yes *08b Cross-contamination, equipment, personnel, storage constructed Yes "08c Potential for cross-contamination; storage practices; STATUS INSECT AND RODENT CONTROL damaged food segregated Yes (35a Presence of insects/rodents. Animals prohibited Yes 109 Foods handled with minimum contact Yes °35b Outer openings protected from insects, rodent proof Yes [10 In use food dispensing utensils property stored STATUS FLOORS. WALLS, CEILINGS STATUS PERSONNEL Yes 36 Floors properly constructed, clean, drained, coved Yes 11 Personnel with infections restricted Yes 37 Walls, ceilings, and attached equipment, constructed, Yes “12a Hands washed and clean, good hygienic practices 1 clean (observed), alternative operating plan Yes 38 Lighting provided as required. Fixtures shielded Yes *12b Proper hygienic practices, eating/drinking/smoking Yes 39 Rooms and equipment - vented as required (evidence) STATUS OTHER AREAS Yes 13 Clean clothes, hair restraints Yes (40 Employee lockers provided and used, clean STATUS FOOD EQUIPMENT AND UTENSILS Yes “41a Toxic items properly stored Yes 14 Food contact surfaces designed, constructed, Yes "41b Toxic items labeled and used properly maintained, installed, located Yes 42 Premises maintained, free of litter, unnecessary articles. | Yes 15 Non-food contact surfaces designed, constructed, Cleaning and maintenance equipment properly stored. maintained, installed, focated Kitchen restricted to authorized personnel Yes 16 Dishwashing facilities designed, constructed, operated Yes a3 Complete separation from tiving/sleeping area, laundry 44 Clean and soiled linen segregated and properly stored SAFETY "45 Fire extinguishers - proper and sufficient Yes 18 Pre-flushed, scraped, soaked Yes 19 Wash, rinse water clean, proper temperature Yes "46 Exiting system - adequate, good repair I Yes *20a Sanitizing concentration No “47 Electrical wiring - adequate, good repair __| Yes *20b Sanitizing temperature Yes “48 Gas appliances - properly installed, maintained Yes 21 Wiping cloths clean, used properly, stored Yes “49 Flammable/combustitle materials - prope-ly stored No 22 Food contact surfaces of equipment and utensils clean STATUS GENERAL . Yes 23 Non-food contact surfaces clean No "50 Current license properly displayed Yes 24 Storage/handling of clean equipment, utensils Yes 51 Other conditions sanitary and safe operation STATUS SINGLE SERVICE ARTICLES Yes "52 False/misleading statements published or advertised Yes 25 Service items properly stored, handled, dispensed relating to food/beverage Yes 26 Single service articles not re-used Yes "53a Food management cartification valid 4j STATUS WATER AND SEWAGE/PLUMBING No “53b Employee training validation Yes faz Water source safe, hot and cold under pressure Yes 54 Florida Clean Indoor Air Act _ Yes *28 Sewage and waste water disposed properiy Yes 55 Automatic Gratuity Notice _ Yes 29 Plumbing installed and maintained Yes |56 Copy of Chapter 509, Florida Statutes. available Yes “30 Cross-connection, back siphonage, backflow STATUS | GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program Information provided No *31 Toilet and hendwashing facilities, number, convenient, |Yes [58 Smoke Free designed, installed (3? Restrooms with self-closing doors, fixtures operate ‘° vopery, facility clean, supplied with handsoap, disposable Total Number of COS Violations 9 towels or hand drying devices, tissue, covered waste Total Number of Repeat Violations: 0 Violations marked with an asterisk are critical violations. Items marked YES are in compliance. !tems Marked NO are violations. Specific details of violation are Iisted on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/O are Not Observed, and were not being conducted Page : STATE OF FLORIDA age 3 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION __ License Number DIVISION OF HOTELS AND RESTAURANTS SEAT 3905018 Inspection Date FOOD SERVICE INSPECTION REPORT 7/26/04 11:28:54 AM LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. Warning(s): 34-10 - Observed missing hand sink in food preparation room or area. front area where sandwiches and pizza are prepared. This viciation must be corrected by : 08/26/94 45-04 - Observed no portable extinguisher with a 2A classification or equivalent for an ordinary hazard. This violation must be corrected by : 08/26/04. 45-23 - Observed the use af cooking equipment producing grease faden vapors/smoke with no hood suppression system installed. observed two small fryers on counter in back kitchen must remove or provide hood system. This violation must be corrected by : 08/26/04. 50-02 - Observed Hotel and Restaurant license not properly displayed. This violation must be corrected by : 08/26/04. 53B-01 - Observed no proof of required employee training. This violation must be corrected by : 08/26/04 Violation(s): 08A-04 - Observed uncovered food. cooked pizza at front counter does not have protection from the public. no sneeze guard. 17-01 - Observed incorrect chemical test kit provided when using chemical sanitizer at three compartment sink. needs chlorine tesl strips. 22-02 - Observed encrusted material on can opener. 32-14 - Observed iack of handwashing cleanser at handwashing lavatory. back area 32-09 - Observed lack of proper hand drying provisions at hand wash sink. back area 47-01 - Observed extension cord in use for non-temporary period. mice cream freezer at front service area.

Docket for Case No: 05-001758