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
Follow-Up
Date 12/20/2024
Time In 11:00 AM
Time Out 01:15 PM
No. of Risk Factor/Intervention Violations:  12 Risk Category
1
No. of Repeat Risk Factor/Intervention Violations:  7 Inspection Result
Red
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   X
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    
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    
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    
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    
22 IN OUT N/A N/O Proper cold holding temperatures   X
23 IN OUT N/A N/O Proper date marking and disposition    
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records    
CONSUMER ADVISORY
 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food   X
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   X
53 OUT Toilet facilities: properly constructed, supplied, & cleaned    
54 OUT Garbage & refuse properly disposed; facilities maintained    
55 OUT Physical facilities installed, maintained & clean   X
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:: Chlorine PPM: Within specified range Heat: NA

CFPM AND HACCP
CFPM Verification (name, expiration date, ID#):
Sydney Davis
Exp. Date: 12/14/2029
ID #: 26653281 		Xiaoxuan Wang
Exp. Date: 03/27/2029
ID #: 25439695 		Guobin Hu
Exp. Date:  
ID #: Enrolled
Exp. Date:
ID #:
HACCP Topic: Proper Handwashing

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
Pork/Table-top warmer 117.00°F Pork/Table-top warmer 155.00°F Broth/Walk-in cooler 51.00°F
Broth/Walk-in cooler 60.00°F Eggs/Ambient air 61.00°F Eggs/Ambient air 64.50°F
Corn/Make table cooler 50.00°F Corn/Make table cooler 55.00°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 (I): When to Wash-After Other Activities Contaminating Hands
Kajiken: An employee touched their bare arms with their gloved hands, continued food service, then wiped their gloved hands on their pants. 		 
15 X X 3-302.11 (A)(1)(a-c): Cross Contamination-Separating Raw Animal FOODS from RTE FOODS or Fruits/Vegetables Before Washed
Kajiken: A box containing flats of raw unpasteurized shell eggs was stored on top of bags of raw onions on the platform near the reach-in freezers (R1). 		 
19 X 3-403.11 (D): TCS FOODS: Reheating For Hot Holding: Reheat Rapidly Not to Exceed 2 Hours
Three containers of cooked and cooled pork were in the temperature range of 117-155 degrees F in the table-top food warmer at 1:10 pm. According to the PIC, these items were taken from a cooler and placed in the warmer at approximately 11:00 am. 		 
20 X X 3-501.14 (A): Cooling-Cooked TCS FOODS
Four lidded stockpots of soup prepared on 12/19 were filled with approximately 8-10 inches of broth and were in the temperature range of 51 to 60 degrees F in the walk-in cooler. Two stock pots of broth from 12/18 were stacked on top of the actively cooling pots of broth (R1). (Note: the broth from 12/18 was 41 degrees F or below). 		 
22 X X 3-501.16(A) (2): TCS FOODS: Cold Holding 41ºF or Less
1) Two boxes containing several flats of raw shell eggs were sitting at room temperature and were in the temperature range of 61 to 64.5 degrees F.
2) Corn (from a can) was in the temperature range of 50 to 55 degrees F in the top portion of the make table cooler (R1). 		 
23 X 3-501.18 (A): Date Marking: Disposition
A container of cream cheese (labeled with a date of opening of "12/6") was held beyond 7 days in the reach-in cooler in Kyo Matcha. 		 
28 X X 7-201.11: POISONOUS OR TOXIC MATERIALS Stored
Several containers of butane gas cartridges and lighters (containing lighter fluid) were stored above boxes of single service lids in the downstairs storage room (R1). 		 
52 X 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 (R1). 		 
1 X 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 (P) and Priority foundation (Pf) violations found during today's follow-up inspection, the PIC is unable to ensure compliance with the Food Code (R1). 		 
10 X 6-301.11: HANDWASHING SINK Provided with Hand Soap
The hand sink behind the front counter was not supplied with hand soap. 		 
13 X 3-202.15: FOOD Condition-Packages
Five metal cans of "sweet red bean topping" were severely dented/damaged, some of which were dented along their hermetic seal. 		 
23 X X 3-501.17 (A): RTE-TCS FOODs: On-Premises Preparation & Hold Cold >24 Hours: Date Marking
1) A bag of cut lettuce (opened yesterday) was not date labeled in the cook line make table reach-in cooler.
2) A cut portion of a head of cabbage was placed in the bulk box containing uncut heads of cabbage. Per the PIC, the cabbage was cut yesterday, but was the item was not date labeled.
3) A pitcher of milk base was not date labeled in the under counter cooler in Kyo Matcha. Another pitcher of milk base in the same cooler was labeled with a preparation date of "12/10". According to the PIC, the milk base was inaccurately labeled and both pitchers were prepared yesterday (12/19) (R1). 		 
 

Person in Charge (Signature)

  Sydney Davis, CFPM 		 

Date:

  12/20/2024
 

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
25 X X 3-603.11: Consumer Advisory--DISCLOSURE and REMINDER
The same dine-in menu from the routine inspection was still in use. The dine-in menu had a disclosure footnote, but the animal-derived foods (eggs) requiring disclosure were not marked with an asterisk. According to the PIC, the new menus were ordered and will be delivered within the next couple of days. Please note, the menus were not adequately corrected per the draft submitted to the inspector after the routine inspection. The take-out menus are no longer in use (R1). 		 
33 X X 3-501.15 (A): FOOD Temperature Control: Cooling Methods
1) As noted in violation #20, improper cooling methods were being used, causing cooked food to not cool within 6 hours.
2) As noted in violation item #22, TCS food (corn) was not cooled to 41 degrees F using rapid cooling methods before being placed in cold holding equipment. 		 
48 X 4-302.14: SANITIZING Solutions: Testing Devices: Test Kit or Other Device
The PIC was unable to provide proof that the facility had chlorine test strips. 		 
43 X 3-304.12 (C): During Pauses in FOOD preparation or Dispensing, UTENSILS Stored: On a Clean FOOD Preparation Table or Cooking EQUIPMENT
Several pairs of tongs were stored on the handle of the oven along the cook line. 		NRI
47 X 4-101.19: Non-FOOD CONTACT SURFACES of EQUIPMENT: Material: Construction and Repair
1) A towel was used to line the bottom of the upper portion of the cook line make table cooler.
2) A towel was attached to the end of the prep sink drain line (to prevent splash). A piece of plastic was also attached to the drain line. 		NRI
48 X X 4-603.12 (B): Cleaning EQUIPMENT and UTENSILS: Precleaning- Preflush, Soak, Scrubbed
Clean containers on the clean dish racks had old date labels and label residue on them. 		NRI
48 X 4-204.119: Sinks and Drainboards of WAREWASHING Sinks and Machines: Self-Draining
Kajiken: Wire racks were installed and used for drying utensils above the drainboards on both sides of the 3-compartment sink, not approved. 		NRI
51 X 5-205.15 (B): PLUMBING SYSTEM: Maintain in Good Repair
Kyo Matcha: The cleanout underneath the 3-compartment sink was leaking water onto the floor. 		NRI
55 X X 6-501.12 (A): PHYSICAL FACILITIES Cleaned As Often As Necessary
Kajiken: The following were soiled: the ceiling vent in the dish area (R1), the caulk at the 3-compartment sink (mold), the ventilation hood filters along the cook line, the floor underneath the equipment along the cook line, and the floor drain near the prep sink.
Kyo Matcha: The following were soiled: the floor under/behind the ice cream machine and the floor under the chest ice machine. There was pooled water on the floor under/near the 3-compartment sink. 		NRI
55 X 6-501.11: PHYSICAL FACILITIES: In Poor Repair
Kajiken: The caulk at the prep sink was in poor repair and the drainboard was separated from the wall.
Kyo Matcha: The escutcheon plate around the water line to the ice cream machine was not sealed to the wall. 		NRI
55 X 6-501.16: Drying Mops
A wet mop head was stored in a mop bucket rather than hung to dry. 		NRI
Inspection Comments Note: The PIC stated that a chemical wash is used to clean produce, but could not provide proof of test strips.

At 1:15 p.m. on 12/20/2024, the food service was closed and the health permit was suspended due to uncontrolled foodborne illness risk factors. All food handling, preparation, and service must cease as of this time. A red Closed placard was posted at a location determined by the health officer. This placard is the property of C-UPHD/ CCPHD and shall not be removed, copied, or altered in any way under penalty of law.

A request for re-inspection was left with the PIC.

Contact rpereira@c-uphd.org with questions. 		 
 

Person in Charge (Signature)

  Sydney Davis, CFPM 		 

Date:

  12/20/2024
 

Environmental Health Specialist (Signature)

  Rachel Pereira 		 

Follow-up:  Yes   No   Follow-up Date: