Devens Enterprise Commission - Finding 2

The Devens Enterprise Commission Was Not Able To Provide Evidence That All Food Inspections Were Performed by the Nashoba Associated Boards of Health, As Required by Section 22 of Chapter 498 of the Acts of 1993.

Overview

DEC was not able to provide evidence that NABH performed all follow-up food inspections. In addition, DEC was not able to provide evidence that NABH addressed repeat instances of noncompliance or that all businesses acknowledged receipt of their food inspections.1⁵ Specifically, 3 (10%) of the 29 food inspections in our sample required follow-up inspections, but DEC was unable to provide 2 of the 3 follow-up reports. Also, of the 6 food inspections in our sample that had items identified as not in compliance, 3 had repeat instances of noncompliance in the same areas. The repeat areas of noncompliance included a lack of proper date-marking and disposal of food, a lack of a testing device that measures the concentration of sanitizing solutions for warewashing¹⁶ facilities, and a lack of procedures for responding to medical events involving bodily fluids. There is no evidence that DEC followed up with NABH about these repeat instances of noncompliance in the same areas. In addition, 4 (14%) of the food inspection reports in our sample did not have signatures from the businesses that acknowledged receipt of the inspection.

If DEC does not receive all documentation related to food inspections, then it cannot ensure that inspections are performed, that businesses acknowledge receipt of inspection, and that NABH completes follow-up inspections or monitors instances of repeat noncompliance. Without ensuring these things, DEC may not know whether businesses are in compliance with state food sanitation standards, leading to a higher-than-acceptable risk that individuals may be exposed to food- or pest-borne illnesses or other potential health risks.

Authoritative Guidance

Section 22 of Chapter 498 of the Acts of 1993 states, “The Commission shall have the right to establish a department or contract for services for inspections relating to public health and safety and inspection services.”

Establishments serving food are required by Section 590.008 of Title 105 of the Code of Massachusetts Regulations (CMR) to pass an inspection before a permit to prepare and serve food is issued. Specifically, 105 CMR 590.008(C) states,

The board of health may renew a permit for an existing food establishment or may issue a permit to a new owner of an existing food establishment after a properly completed application is submitted, reviewed, and approved, the fees are paid, and an inspection shows that the establishment is in compliance with 105 CMR 590.000.

Further, 105 CMR 590.008(K)(B) states,

If an inspection reveals that a food establishment does not comply with 105 CMR 590.000, the board of health or its agent shall notify the permit holder or person in charge of the violations and shall order the permit holder to correct the violations. The inspection report may, if so stated, constitute an order to correct, or the board of health or its authorized agent may issue a separate order. An order to correct shall include, but need not be limited to the following: . . .

(f)   The signature of the person in charge of the food establishment at the time of the inspection, or other proof of service of the order.

Reasons for Issue

DEC relied on NABH to provide DEC with copies of all inspections but did not have a written contract (see Finding 1) that described what documentation should be provided and on what schedule. Additionally, DEC management stated in an email to us dated March 21, 2025, “Not all violations reported on inspection reports are serious enough to warrant a follow-up inspection.” According to DEC management, for these types of inspection reports, the violations are discussed with the owner/manager of the business and reinspected during a spot inspection or the next annual inspection. For serious violations, NABH copies DEC on the notice to the business and informs DEC when the issue is resolved. 

Recommendations

1. DEC should maintain a log of food safety inspections to ensure that all required inspections, both annual and follow-up inspections, have occurred and that it receives copies of these inspection reports.
2. DEC should work with NABH to monitor and resolve all instances of noncompliance and ensure that all businesses acknowledge receipt of the inspections.

Auditee’s Response

It is important to note that the audit period includes a period that included a global pandemic. A number of facilities were shut down for extended periods so inspection times did vary. Inspectors and DEC staff were extremely busy with the added tasks of disseminating information and responding to inquiries about the virus and health and safety procedures that were evolving on a daily basis. This is not an excuse to ignore other health and safety inspection issues — especially related to food service, but it should be recognized that priorities did shift to adapt to a fluid and dynamic situation. The majority of repeat instances of non-compliance were more administrative process-related. Those repeat issues, while minimal, would have been rectified at the following inspection which may have been outside of the audit period. That being said, we welcome these recommendations and will work to implement them to help improve our overall tracking and management of these important public health-related inspections.

Auditor’s Reply

Based on its response, DEC is taking measures to address our concerns regarding this matter. As part of our post-audit review process, we will follow up on this matter in approximately six months. 

15.    It is important that businesses acknowledge receipt of food inspection results because they are required to do so and because it provides evidence that the businesses are aware of any issues found during the inspection so that they can resolve them.

16.    According to the 2013 Food Code, published by the US Department of Health and Human Services, warewashing “means the cleaning and sanitizing of utensils and food-contact surfaces of equipment.”

Date published:	June 16, 2025