STATE OF FLORIDA ees DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA‘’ DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ~~ Petitioner, CD lo | OX vs, License No. 6214872 WILDFLOWER Ales dent License Type 2010 Permanent Food Service espon ; . Case No. 2005063245 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against WILDFLOWER 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 1465 S FT HARRISON AVE #105, CLEARWATER, FLORIDA 33756.The mailing address of record is WILDFLOWER CAFE, at 1465 S FT HARRISON AVE #105, CLEARWATER, FLORIDA 33756. 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 thergto. Signed December 13, me Joe Perez, District Manager By delegation of the Director, or designee 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 N BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2005 Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2005063245 : Form revised 11.10.05 License Type: 2010 Permanent Food Service District Number: 03 License Number: 6214872 WILDFLOWER CAFE License Number: 6214872 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2005063245 Exhibit A “FC” as cited herein references specific provisions of the 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 Prevention, General Provisions”, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. It is alleged that on October 19, 2005 and November 22, 2005 the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (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. 1. 02-26-1 3-302.12 FC:: FOOD STORAGE CONTAINERS, IDENTIFIED WITH COMMON NAME OF FOOD. 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 IDENTIFIED WITH THE COMMON NAME OF THE FOOD EXCEPT THAT CONTAINERS HOLDING FOOD THAT CAN BE READILY AND UNMISTAKABLY RECOGNIZED SUCH AS DRY PASTA NEED NOT BE IDENTIFIED. OBSERVED FOOD CONTAINER NOT PROPERLY LABELED FLOUR AND SUGAR. * 2.08A-29-1 3-302.41(A)(4) FC: (A) FOOD SHALL BE PROTECTED FROM CROSS CONTAMINATION BY: (4) STORING THE FOOD IN PACKAGES, COVERED CONTAINERS, OR WRAPPINGS; OBSERVED UNCOVERED FOOD IN HOLDING UNIT/DRY STORAGE AREA. 3. 37-14-1 61C-1.004(6) FAC:: (6) ALL BUILDING STRUCTURAL COMPONENTS, ATTACHMENTS AND FIXTURES SHALL BE KEPT IN GOOD REPAIR, CLEAN AND FREE OF OBSTRUCTIONS. OBSERVED CEILING IN DISREPAIR IN KITCHEN. : * 4,45-09-1 NFPA 96, 10.5.1:: A READILY ACCESSIBLE MEANS FOR MANUAL ACTIVATION SHALL BE LOCATED BETWEEN 42 INCHES AND 48 INCHES ABOVE THE FLOOR, BE ACCESSIBLE IN THE EVENT OF A FIRE, BE LOCATED IN A PATH OF EGRESS, AND CLEARLY IDENTIFY THE HAZARD PROTECTED. EXIT SIGNS NOT PROPERLY ILLUMINATED ABOVE FRONT DOOR. Case Number 2005063245 Form revised 11.10.05 License Type: 2010 Permanent Food Service District Number: 03 License Number; 6214872 WILDFLOWER CAFE Page 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EXH DIVISION OF HOTELS AND RESTAURANTS IBIT B . www. myflorida.com/dbpr CALLBACK INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may Initiate an administrative complaint that may result in suspension or revacatian of your license andiines, 11/22/05 2:39:03 PM Warning SEAG214872 SEAT Callback Inspection Date and Time Inspection Reason License Number WILD FLOWER CAFE OF CLEARWATER, | Administrative Complaint Callback Not 4474497 Owner Name Complied ; Area Cade/Telephone Number WILDFLOWER CAFE Business Name (nspection Result 57 10/49/2005 Number of Units Requested Callback Date/Time Initial Warning Date 1465 § FT HARRISON AVE #105 CLEARWATER FL 33756 Address / City / State / Zip / ete, Comments ee he following item(s) have been recommended for Administrative Camplaint; lolation: 02-21-1 bserved food container not properly labeled flour and sugar. talation: OBA-25-1 yserved uncovered food In halding univdty storage area, lolatian: 37-14-14 2 Gara Wipe EU Ce 11/22/05 Date Signature of Recipient Inspector Signature Reciptent: Peggy George For further information please contact: Tith Marcie Ellerman . Manager In Charge Sanitation and Safety Specialist 3725 W. Grace St. Phone: 727-447-4497 #520 Tampa, Fl. 33607 850-487-1395 DBPR Form HR 5022-005 EXHIBIT B rasez STATE OF FLORIDA License Number DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEAT SEAS214872 DIVISION OF HOTELS AND RESTAURANTS Business Name www. myflorida.com/dbpr WILDFLOWER CAFE Inspection Date CALLBACK INSPECTION REPORT 11/22/05 2:39:03PM LEGAL NOTICE Fallure to comply with this Notice May Initiate an administrative complaint that may result in suspension or revocation of your license andfines. ~ Dotserved ceillng In disrepair in kitchen. folation: 46-09-1 Exitsions not properly Illuminated above frant door, The faflawing item(s) are in compliance: Matson: 05-08-1 lo conspicuously facated thermometer in holding unit reach-in, lolatian: 14-37-1 bserved cutilng board groovedipitied and no longer cleanable,at sandwich area, lotattan: 30-02-1 issing backilow preventer at three compartment sink hose. iotation: 47-08-1 Poserved extension cord In use for non-lemporary period for fan over three compartment sink. Molation: 47-13-1 prea breaker box blocked and/or Inaccessibte, pots hanging In frant of box. lolation: 53B-08~1 lo proof of required employee training provited. All Public food service establishments must provide the dlvisian with praof of employee tratning upon request, Including, but nt limited to, at the time of any division Inspection of the establishment, Pro BPR Form HR 5022-005 Fallure to comply with this Notice may Initiate an administrative 10/19/05 2:30:07 PM inspection Date and Time WILD FLOWER CAFE OF CLEARWATER, ! STATE OF FLORIDA Page 1 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EXHIBIT B DIVISION OF HOTELS AND RESTAURANTS ~ www. nyflorida,com/dbpr FOOD SERVICE INSPECTION REPORT LEGAL NOTICE complaint that may result In suspension or ravocation of your licanse andfnes. Routing 6214872 SEAT Inspection Reason License Number WARNING: Owner Name WILDFLOWER CAFE 4474497 Violations in the operation of your Area Code/Telephane Number lishment must be corrected by: _ Business Name 57 Inspection Resutt Number of Units 11/20/2005 08:00 AM 02/01/06 Callback Date/Time License Expiration 1465 S FT HARRISON AVE #105 CLEARWATER FL 33756 Adtirass / City / State / Zip / etc, --——_— ttem 03: Food Temperatures Item 53a: Cert. Food Managers — Item 20: Warewashing Sanitization Beel, prep area, 40 Degrees F, Manager Name: Leslie Alfred Certification Date: 06/12/01 Centifiad by; Florida Restaurant Beef, reach tn cooler, 40 Degrecs F, Association Quiche, reach in cooler, 40 Degrees F, tuna salad, front line, 38 Degrees F. chicken salad, front line, 38 Degrees F, —,Fire Suppression Systems Dates _| Item 45; Fire Extinguishers and Sanilizer Type: Chiorine found at conceniratlon of 100ppm PPM, a * JA Class ABC (ype Fire Extinguisher, found wat 4 Class BC lype Fire Extinguisher, foundinvat Kitchen has a centMication date of 1404 ‘A Hood Suppression type Fire Exttnquisher, found ial klichen has a cenificalion dale ot 05105 dining room has a rentificallon date of 11104 NOTE: Items marked above with an asterisk {*) indicate a violation inspector's Comments Water Source: Municipal/Utllity. Sewage: Municipat/Utility, Provided Web Site: www. myflorida.com/dbpr | acknowledge receipt of this Inspection form and comments, QL epee —_— 10/19/05 Date Signature of Recipient Zep Cl Inspector Signature Recipient: Joan Dragon For further information please contact: Marcie Ellerman Title Owner Sanitation and Safely Specialist 3725 W. Grace St. #520 Tampa, Fl Phone: 727-447-4497 80-47-1095 STATUS SOURCE STATUS PHF TEMPERATURE CONTROL Yes “Ota Approved source “03b Hot food at proper temperature IYes *01b Wholesome, sound condition *03c Foods properly cooked/eheated No 02 Original container; properly labeled, date marking “03d Foods properly cooled STATUS PHF TEMPERATURE CONTROL Yes “04 Facilities to maintain product temperature Yes “03a Cold food at proper temperatures during storage, No *05 Thermometers provided and conspicuously placed [ display, service, transport, and cold holding Yes *06 Potentially hazardous foods properly thawed Violations marked with an asterisk are critical violations. tems marked YES are In compliance. tems Marked NO are violations, Specific detalls of violation are listed on subsequent pages, Items marked N/A are Not Applicable, Items Marked as N/O are Nol Observed, and were not being conducted at the lime of Inspection. DBPR Form HR 5022-015 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS wew.myflorida.com/dbpr FOOD SERVICE INSPECTION REPORT ree EXHIBIT B license Number SEAT 6214872 Inspection Date 10/19/05 2:30:07 PN LEGAL NOTICE Fallure to comply with this Notice may tnitiate an administrative complaint that may result in suspension or revocation of your license andfines. 1. Wash 2, Rinse 3. Sanitize “17 Thermometers, gauges, test kits provided STATUS PHF TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL lYes_ 07 Unwrapped or potentially hazardous food nat re-served [Yes “laa Containers covered, adequate number, insect and todent No "08a Food protection during storage, preparation, display, Proof, emptied at proper intervals, clean service, transportation Yes 34 Outside storage area clean, enclosure properly Yes *O8b Cross-contamination, Equipment, personnel, storage constructed Yes 8c Potential for cross-contamination; storage practices; INSECT AND RODENT CONTROL damaged food segregated 35a Presence of insects/rodents. Animals prohibited Yes *09 Foods handled with minimum contact '35b Outer openings protected from insects, rodent proof Yes 10 In use food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS STATUS PERSONNEL 96 Floors properly constructed, clean, drained, coved | Yes "41 Personnel with Infections restricted No 37 Walls, ceilings, and attached equipment, constructed, I" “12a Hands washed and clean, good hygienic practices clean (observed), alternative operating plan = {38 Lighting provided as required, Fixtures shielded Yes “12b Proper byglenic practices, eating/drinking/smoking Yes 39 Rooms and equipment - vented as fequired (evidence) : STATUS OTHER AREAS Yes 13 Clean clothes, hair restraints Yes 40 Employee lockers providect and used, clean STATUS FOOD EQUIPMENT AND UTENSILS Iv es _{'41a Toxlc items properly stored No 14 Food contact surfaces designed, constructed, [Yes *41b Toxic ttems labeled and used properly maintained, Installed, located Yes laa Premises maintained, free of litter, unnecessary arlitles, Yes 18 Non-food contact surfaces designed, constructed, Cleaning and maintenance equipment properly stared, maintained, installed, located . Kitchen restricted to authorized personnel “16 Dishwashing facilities designed, constructed, operated |Yes 18 Pre-flushed, scraped, soaked STATUS *45 Fire extinguishers proper and sufficient Yes 19 Wash, rinse water clean, proper temperature No "46 Exiting system - adequate, good repair Ye . " Ni Ns, ing - ites 20a Sanitizing concentration | 0 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/combustible materiats - properly stored Yes 22 Food contact surfaces of equipment and utensils clean GENERAL Yes 23 Non-food contact surfaces clean Yes “50 Current license property displayed Yes 24 Storage/handling of Clean equipment, utensils _|Yes 51 Other conditions sanitary and safe operation 7 STATUS SINGLE SERVICE ARTICLES Yes 52 False/misleading statements published or advertised Yes 25 Service ilems properly stored, handled, dispensed relating ta fond/beverage Yes 26 Single service articles not re-used Yes 53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING No *53b Employee training validation Yes “27 Water source safe, hot and cold under pressure Yes 84 Florida Clean Indoor Air Act Yes “28 Sewage and waste water disposed properly _ Yes 55 Automatic Gratuity Notice Yes 29 Plumbing installed and maintained Yes _|56 Copy of Chapter 509, Florida Statutes, available No “30 Crass-connection, back siphanage, backflow STATUS GENERAL led Yes 57 Hospitality Education Program Information provich STATUS TOILET AND HANDWASHING FACILITIES Yes “31 Toilet and handwashing facilities, number, convenient, designed, installed Yes 32 Restrooms with self-closing doors, fixtures Operate property, facility clean, supplied with handsoap, disposable towels or hand drying devices, tissue, covered waste receptacles Yes 58 Smoke Free — __ 0 0 Total Number of COS Violations: Total Number of Repeat Violations: Violatians marked with an asterisk are critical violations, Items marked YES are in com subsequent pages. liems marked N/A are Not Applicable, Items Marked as NYO are Ni DBPR Form HR 5022-015 jpllance, llems Marked NO are violations. Specific delalls of violation are listed on lo! Observed, and were not being conducted at the lime of inspection. STATE OF FLORIDA Page 3 EXHI Bl T B DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION — License Number DIVISION OF HOTELS AND RESTAURANTS SEAT — 6214872 www. myflorida.com/dbpr Inspection Date 10/19/05 2:30:07 PK FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Warningis): 02-21-1 -Observed food container nat properly tabeled flour and sugar, O5-09-1 -No conspleuously located thermometer tn holding unit reach-tn, O8A-29-1- Observed uncovered food fn holding univdry storage area, 14-37-1 -Observed culting board grooved/pitted and no ionger cleanable,at sandwich area, 30-021 - Missing backllow preventer at {hree compartment sink hose. 37-14-14 - Observed Calling In disrepair In kiichen, 46-09-1 - Exit signs not Properly Iltuminated above frant door, 47-06-1 - Observed extension cord in use for non-temporary period for fan Over three compartment sink, 47-13-1 ~ Clreuit breaker box blocked and/or inaccessible, pas hanging tn front of box, Including, but not limited to, at the time of any division Inspection of the establishment. Pro 53B-03-1 «No proof of required emptayee {raining provided. Alt public food service establishments must provide the division with proof of employee tralning upon request, DEPR Form HR 5022-015

Docket for Case No: 06-001087