CHAMPAIGN-URBANA PUBLIC HEALTH DISTRICT
201 W. Kenyon Rd
Champaign, Illinois 61820-7807
217-373-7900     www.c-uphd.org
 		 

Food Establishment Inspection Report
Page 1  of ????????? 
Establishment Name
Kajiken / Kyo Matcha 		Permit #
3747
Street Address
617 E Green ST
City/State
Champaign, IL 		ZIP Code
61820
Owner/Manager
Mia Wan
Purpose of Inspection
Routine
Date 11/22/2024
Time In 11:00 AM
Time Out 03:20 PM
No. of Risk Factor/Intervention Violations:  13 Risk Category
1
No. of Repeat Risk Factor/Intervention Violations:  0 Inspection Result
Yellow
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item
IN=in compliance    OUT=not in compliance    N/O=not observed    N/A=not applicable
Mark "X" in appropriate box for COS and/or R
COS=corrected on-site during inspection    R=repeat violation 		Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury.
 Compliance Status
 COS R
SUPERVISION
 
1 IN OUT     Person in charge present, demonstrates knowledge, and performs duties    
2 IN OUT N/A   Certified Food Protection Manager    
EMPLOYEE HEALTH
 
3 IN OUT     Management, food employee and conditional employee; knowledge, responsibilities and reporting    
4 IN OUT     Proper use of restriction and exclusion    
5 IN OUT     Procedures for responding to vomiting and diarrheal events    
GOOD HYGIENIC PRACTICES
 
6 IN OUT   N/O Proper eating, tasting, drinking, or tobacco use    
7 IN OUT   N/O No discharge from eyes, nose, and mouth    
PREVENTING CONTAMINATION BY HANDS
 
8 IN OUT   N/O Hands clean & properly washed X  
9 IN OUT N/A N/O No bare hand contact with RTE food or a pre-approved alternative procedure properly allowed    
10 IN OUT     Adequate handwashing sinks properly supplied and accessible X  
APPROVED SOURCE
 
11 IN OUT     Food obtained from approved source    
12 IN OUT N/A N/O Food received at proper temperature    
13 IN OUT     Food in good condition, safe, & unadulterated X  
14 IN OUT N/A N/O Required records available: shellstock tags, parasite destruction    
 Compliance Status
 COS R
PROTECTION FROM CONTAMINATION
 
15 IN OUT N/A N/O Food separated and protected X  
16 IN OUT N/A   Food-contact surfaces: cleaned & sanitized    
17 IN OUT     Proper disposition of returned, previously served, reconditioned & unsafe food    
TIME/TEMPERATURE CONTROL FOR SAFETY
 
18 IN OUT N/A N/O Proper cooking time & temperatures    
19 IN OUT N/A N/O Proper reheating procedures for hot holding    
20 IN OUT N/A N/O Proper cooling time and temperature X  
21 IN OUT N/A N/O Proper hot holding temperatures X  
22 IN OUT N/A N/O Proper cold holding temperatures X  
23 IN OUT N/A N/O Proper date marking and disposition X  
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records X  
CONSUMER ADVISORY
 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food    
HIGHLY SUSCEPTIBLE POPULATIONS
 
26 IN OUT N/A   Pasteurized foods used; prohibited foods not offered    
FOOD/COLOR ADDITIVES AND TOXIC SUBSTANCES
 
27 IN OUT N/A   Food additives: approved and properly used    
28 IN OUT N/A   Toxic substances properly identified, stored, & used X  
CONFORMANCE WITH APPROVED PROCEDURES
 
29 IN OUT N/A   Compliance with variance/specialized process/HACCP    

GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods.
In the sections below, red circle=out of compliance       Mark "X" in appropriate box for COS and/or R      
COS
=corrected on site during inspection    
R
=repeat violation  
 Compliance Status
 COS R
SAFE FOOD AND WATER
 
30 OUT Pasteurized eggs used where required    
31 OUT Water & ice from approved source    
32 OUT Variance obtained for specialized processing methods    
FOOD TEMPERATURE CONTROL
 
33 OUT Proper cooling methods used; adequate equipment for temperature control X  
34 OUT Plant food properly cooked for hot holding    
35 OUT Approved thawing methods used    
36 OUT Thermometers provided & accurate    
FOOD IDENTIFICATION
 
37 OUT Food properly labeled; original container    
PREVENTION OF FOOD CONTAMINATION
 
38 OUT Insects, rodents, & animals not present    
39 OUT Contamination prevented during food preparation, storage & display    
40 OUT Personal cleanliness    
41 OUT Wiping cloths: properly used & stored    
42 OUT Washing fruits & vegetables    
 Compliance Status
 COS R
PROPER USE OF UTENSILS
 
43 OUT In-use utensils: properly stored    
44 OUT Utensils, equipment & linens: properly stored, dried, & handled    
45 OUT Single-use/single-service articles: properly stored & used    
46 OUT Gloves used properly    
UTENSILS, EQUIPMENT, AND VENDING
 
47 OUT Food & non-food contact surfaces cleanable, properly designed, constructed & used    
48 OUT Warewashing facilities: installed, maintained & used; test strips    
49 OUT Non-food contact surfaces clean    
PHYSICAL FACILITIES
 
50 OUT Hot & cold water available; adequate pressure    
51 OUT Plumbing installed; proper backflow devices    
52 OUT Sewage & waste water properly disposed    
53 OUT Toilet facilities: properly constructed, supplied, & cleaned    
54 OUT Garbage & refuse properly disposed; facilities maintained    
55 OUT Physical facilities installed, maintained & clean    
56 OUT Adequate ventilation & lighting; designated areas used    
EMPLOYEE TRAINING
 
57 OUT All food employees have food handler training    
58 OUT Allergen training as required    

Food Establishment Inspection Report
Page 2  of ?????? 
Establishment Name: Kajiken / Kyo Matcha Permit #: 3747
Water Supply:   Public Private   Waste Water System:   Public Private
Sanitizer Type:: QUAT PPM: Within specified range Heat: NA

CFPM AND HACCP
CFPM Verification (name, expiration date, ID#):
Xiaoxuan Wang
Exp. Date: 03/27/2029
ID #: 25439695 		Sydney Davis
Exp. Date:  
ID #: Enrolled
Exp. Date:
ID #:
Exp. Date:
ID #:
HACCP Topic: Proper Handwashing

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
Beef/Walk-in cooler 43.70°F Beef/Walk-in cooler 46.80°F Chicken/Walk-in cooler 44.60°F
Chicken/Walk-in cooler 47.00°F Beef/Walk-in cooler 49.10°F Beef/Make table reach-in cooler 51.00°F
Tofu/Make table reach-in cooler 43.00°F Tofu/Make table reach-in cooler 46.40°F Ube cream/Make table reach-in cooler 45.00°F
Matcha cream/Make table reach-in cooler 46.00°F Cooked bok choy/Counter 96.00°F Cooked bok choy/Counter 114.00°F
     

OBSERVATIONS AND CORRECTIVE ACTIONS
Item
No. 		P Pf C R Violations cited in this report must be corrected within the timeframes below.
NRI=Next Routine Inspection 		Correction
Date
8 X 2-301.14 (H): When to Wash-Before Donning Gloves
During two separate instances two different employees went to put on gloves to resume food service without first washing their hands.
COS: Educated. The employees washed their hands. 		COS
13 X 3-101.11: FOOD Condition-Safe/Unadulterated/Honestly Presented
There was a moldy tomato in the walk-in cooler.
COS: Discarded. 		COS
15 X 3-302.11 (A)(1)(a-c): Cross Contamination-Separating Raw Animal FOODS from RTE FOODS or Fruits/Vegetables Before Washed
KYO MATCHA: Flats of raw, unpasteurized shell eggs were stored above gallons of milk in the 2-door reach-in cooler.
COS: The PIC moved the eggs to the bottom shelf. 		COS
20 X 3-501.14 (A): Cooling-Cooked TCS FOODS
1) A container of cooked beef filled approximately 4 to 6 inches high was in the temperature range of 43.7 to 46.8 degrees F in the walk-in cooler. The pieces of meat were each 2 inches or more in thickness. The meat was cooked yesterday, on 11/21/2024. The container was covered with plastic wrap.
COS: Discussed slicing meat into thinner portions/using sheet pans to ensure thinner portions are placed into the walk-in cooler. Discussed implementing hourly temperature checks and using temperature logs. The PIC discarded the beef.
2) Two lidded containers of cooked chicken contained product in the temperature range of 44.6 to 47 degrees F in the walk-in cooler. There was approximately 3 inches of chicken in each container and the containers were stored with one stacked on top of the other. The chicken was cooked and placed in the walk-in cooler yesterday on 11/21/2024.
COS: Discussed leaving cooling foods uncovered. The PIC discarded the chicken.
3) A lidded container of cooked beef with approximately 4-5 inches of product was 49.1 degrees F in the walk-in cooler. The container of beef was prepared on 11/20.
Note: a smaller container of beef was portioned from this bulk container earlier today, was placed in the make table reach-in cooler, and was found at 51 degrees F. The beef was labeled with the date it was portioned (11/22) rather than the date of prep from the bulk container (11/20).
COS: The PIC discarded both the bulk container and the smaller portioned container. 		COS
21 X 3-501.16(A) (1): TCS FOODS: Hot Holding 135°F or above, except roasts 130°F or above
A small container of cooked bok choy was in the temperature range of 96 to 114 degrees F near the tabletop steamtable unit along the cook line. According to the PIC, it was prepared at 11:00 am.
COS: Discussed using hot holding equipment. Temporary TPHC was allowed for 4-hour use. Any remaining product will be discarded at 3:00 pm. 		COS
22 X 3-501.16(A) (2): TCS FOODS: Cold Holding 41ºF or Less
1) A container of cooked beef was 51 degrees F in the make table reach-in cooler along the cook line. As noted in violation item #20, the beef was prepared on 11/20 and did not cool to 41 degrees F or below within 6 hours.
COS: Discarded. Discussed not placing food that is above 41 degrees F in cold holding equipment.
2) A plate of tofu was in the temperature range of 43 to 46.4 degrees F above the load limit in the top portion of the make table cooler along the cook line. The lid of the make table cooler was left open in between use. According to the PIC, the tofu was prepared within the past 10 minutes.
COS: The PIC moved the tofu to the walk-in cooler to cool.
3) At 12:00 pm, a container of facility-prepared ube cream (containing powdered milk and heavy whipping cream) was 45 degrees F in the Kyo Matcha make table reach-in cooler. Facility-prepared matcha cream was 46 degrees F in the same make table reach-in cooler. According to the PIC, they were prepared at 11:00 AM.
COS: The PIC moved the cream to the walk-in cooler. 		COS
28 X 7-201.11: POISONOUS OR TOXIC MATERIALS Stored
1) Kajiken: Two spray bottles of multi-purpose cleaner were hanging on the wire rack below the front counter with their sprayer nozzles pointed towards an opened box of individually packaged single service spoons and single service bags.
COS: The PIC moved the spoons and bags to the top shelf and the chemicals to the bottom shelf.
2) Kyo Matcha: A spray bottle of multi-purpose cleaner was hanging above single service bags on the wire rack underneath the front counter.
COS: The cleaner was moved to the chemical storage rack. 		COS
 

Person in Charge (Signature)

  Xiaoxuan Wang, CFPM 		 

Date:

  11/22/2024
 

Environmental Health Specialist (Signature)

  Rachel Pereira 		 

Follow-up:  Yes   No   Follow-up Date:

Food Establishment Inspection Report
Page 3  of ?????? 
Establishment Name: Kajiken / Kyo Matcha Permit #: 3747

OBSERVATIONS AND CORRECTIVE ACTIONS
Item
No. 		P Pf C R Violations cited in this report must be corrected within the timeframes below.
NRI=Next Routine Inspection 		Correction
Date
52 X 5-402.11(A): EQUIPMENT Drains-Direct Connection
The drain line from the ice cream machine in Kyo Matcha was a flexible tube that extended into the floor drain, not approved.
VCF: Replace the flexible tubing with hard pipe and provide an air gap of at least 1 inch in between the drain line and the floor drain by 12/10/2024. 		12/10/2024
1 X 2-103.11 (A-P): Person In Charge Duties (A-P) Verify Person-In-Charge is able to ensure compliance with Food Code.
As evidenced by the priority and priority foundation violations found during today's routine inspection, the PIC is unable to ensure compliance with the Food Code.
VCF: Provide the following by 12/10/2024:
1) Proof of CFPM certification for an additional employee
2) Submission of a schedule demonstrating full CFPM coverage during all hours of operation
3) Submission of written long-term corrective action for all Priority and Priority foundation violations found during today's routine inspection. 		12/10/2024
10 X 5-205.11 (A): HANDWASHING SINK Accessible
A container of bok choy was resting across the hand sink adjacent to the walk-in cooler, rendering it inaccessible for use.
COS: The container of bok choy was moved. 		COS
23 X 3-501.17 (A): RTE-TCS FOODs: On-Premises Preparation & Hold Cold >24 Hours: Date Marking
1) Four stockpots of broth were not labeled with a date of preparation in the walk-in cooler. The PIC identified that the broth was prepared on Wednesday, 11/20/2024.
COS: Labeled.
2) A container of cut lettuce (prepared yesterday, 11/21/2024) was unlabeled in the make table reach-in cooler near the cook line.
COS: Labeled.
3) A container of cook beef was incorrectly labeled with the date of portioning (11/22) rather than the date of preparation (11/20) in the make table reach-in cooler.
COS: This food was discarded due to temperature abuse.
4) A container of soft boiled eggs was incorrectly labeled with a preparation date of 10/29/2024. According to the PIC, the eggs were prepared on 11/20/2024. According to the PIC, the container was cleaned before being used for food storage on 11/20/2024.
Note: several containers on the clean dish rack had old date labels on them. Discussed ensuring old labels are removed.
COS: The label was updated. 		COS
24 X 3-501.19 (B) (2): TPHC-Maximum up to 4 Hours-Time Marking
Tapioca pearls where TPHC was being used were not time marked on the counter in Kyo Matcha. According to the PIC, they were prepared at 11:00 AM.
COS: The container was labeled with a time of discard of 3:00 PM, per the approved TPHC procedure on file. 		COS
24 X 3-501.19 (A) (1): TPHC-Working Supply Before Cooking or RTE for Display-Written Procedures
TPHC was being used for rice mochi in Kyo Matcha -- not approved.
COS: The rice mochi was discarded. 		COS
25 X 3-603.11: Consumer Advisory--DISCLOSURE and REMINDER
The dine-in and takeout menus had a disclosure footnote, but the animal-derived foods (eggs) requiring disclosure were not marked with an asterisk on either menu.
VCF: Provide corrected menus by 12/10/2024. 		12/10/2024
33 X 3-501.15 (A): FOOD Temperature Control: Cooling Methods
1) As noted in violation item #20, improper cooling methods were being used, causing cooked food to not cool within 6 hours.
COS: Educated. Discarded.
2) As noted in violation item #22, TCS food was not cooled to 41 degrees F using rapid cooling methods before being placed in cold holding equipment.
COS: Educated. Applicable foods were moved to the walk-in cooler. 		COS
47 X 4-101.11 (B): Materials for Construction and Repair: Multiuse UTENSILS and FOOD-CONTACT SURFACES of EQUIPMENT: Durable, CORROSION-RESISTANT, and Nonabsorbent.
Diced mango and coconut cream was stored in its open, original metal cans in the Kyo Matcha 2-door reach-in cooler in the back kitchen area. 		NRI
48 X 4-603.12 (B): Cleaning EQUIPMENT and UTENSILS: Precleaning- Preflush, Soak, Scrubbed
Clean containers on the clean dish rack still had old date labels on them.
Note: The PIC was educated. 		NRI
49 X 4-601.11(C): Non-FOOD CONTACT SURFACES-EQUIPMENT: Clean
Some of the racks in the walk-in cooler were soiled. The bottom interior of both of the 1-door reach-in freezers in Kajiken were soiled. 		NRI
55 X 6-501.12 (A): PHYSICAL FACILITIES Cleaned As Often As Necessary
The ceiling vent in the Kajiken dish area was soiled. The floor edges were soiled in the walk-in cooler. 		NRI
Inspection Comments Violations were cited in six or more of the eleven Foodborne Illness Risk Factors and Public Health Interventions categories. As a result, a yellow Food Safety Alert inspection notice placard was posted at the facility. A Corrective Action Plan for Food Safety was left with the CFPM-PIC.

Correct all Priority (P) and Priority foundation (Pf) violations cited in the report. A Follow-up inspection will be conducted to verify compliance in approximately 20 business days. IF VIOLATIONS ARE FOUND IN ANY OF THE SAME RISK FACTORS OR PHI CATEGORIES DURING THE FOLLOW-UP INSPECTION, THEN THE FOOD SERVICE WILL BE CLOSED AND A RED PLACARD WILL BE POSTED.

Today a Violation Correction Form (VCF) was issued, requiring the following corrections by 12/10/2024:
1) Proof of CFPM certification for an additional employee
2) Submission of a schedule demonstrating full CFPM coverage during all hours of operation
3) Submission of written long-term corrective action for all Priority and Priority foundation violations found during today's routine inspection.
4) Correcting the consumer advisory on both the dine-in and the takeout menus
5) Hard piping the ice cream machine and providing an air gap of at least 1 inch between the drain line and the floor drain.

Discussion note: The PIC provided proof of enrollment for Sydney Davis in a ServSafe CFPM course.

Contact the inspector with questions at rpereira@c-uphd.org. 		 
 

Person in Charge (Signature)

  Xiaoxuan Wang, CFPM 		 

Date:

  11/22/2024
 

Environmental Health Specialist (Signature)

  Rachel Pereira 		 

Follow-up:  Yes   No   Follow-up Date: