The Healthy Skeptic: The ABCs of restaurant grades


At a time when foodborne outbreaks are in the headlines, a restaurant’s health score may seem even more important than its reviews. A big C on the front door won’t exactly whet the appetite, but an A gives you a sense of security.

Cleanliness matters. A single rag dripping with E. coli bacteria could ruin a beef Wellington, and it only takes one unwashed hand to turn pasta primavera into a norovirus surprise.

Restaurant inspections have definitely helped prevent outbreaks across the country, says food safety expert Margaret Binkley, an assistant professor in the department of consumer sciences at Ohio State University in Columbus. But the grades hanging in the window — or even a full report on public health websites — offer only a vague glimpse of the real risk of foodborne illness, Binkley says. “These places are often open 365 days a year, 12 hours a day,” she says. “A two-hour inspection is only going to be a very small snapshot.”


And snapshots can be misleading: You can’t know what’s happening at a restaurant on any particular day. Just one example: A Pakistani restaurant in the greater L.A. area that we won’t name has an A rating now, and, according to the Los Angeles Department of Public Health database (, it has a recent history of sailing through inspections with high marks. But the department also reports that the restaurant had to be shut down for three days in May for “vermin infestation” and an undefined “imminent health hazard to public health or safety.”

Likewise, a popular martini bar in Los Angeles that has an A rating now had to be shut down for three days in June for a major cockroach infestation and “gross contamination of utensils/equipment.”

Out of necessity, inspectors tend to focus on things that can be easily checked, such as the temperature of a walk-in fridge, the cleanliness of the floors and countertops or whether cockroaches and mice have set up shop in the pantry. But these factors may not have much to do with actual diseases, says Benjamin Chapman, a food safety specialist at North Carolina State University in Raleigh. “You can’t look at an inspection report and know how likely you are to get sick,” he says.

Chapman says he would want to know one thing about a restaurant — and it’s not the health score. “I want to know whether workers are washing their hands.”

He notes that noroviruses — a leading cause of foodborne illness — are spread primarily through contaminated hands. (These viruses, which have also made the rounds on cruise ships in recent years, can cause diarrhea, vomiting, muscle aches and a mild fever.) And, he adds, restaurants often get shut down for violations that are much less dangerous than unwashed hands. “A cockroach infestation is not going to increase the chances that you’re going to get sick.”

A study of restaurant outbreaks in eight states in the early 2000s found that noroviruses accounted for nearly half of all cases, with salmonella bacteria a very distant second. In one notable case, noroviruses were implicated in a 2006 outbreak that sickened nearly 400 customers of an Olive Garden restaurant in Indianapolis.


Restaurant inspection practices vary widely from state to state and from county to county. The often-emulated program in Los Angeles County uses a 100-point system. Inspectors deduct six points for a major violation such as severe rodent infestation or a cook with an open wound. Less severe infractions, such as storing raw chicken near salad vegetables, might cost a restaurant four points, and minor violations, such as unclean wiping cloths or a few stray cockroaches or mice, count for one point. Any score between 90 and 100 counts as an A, a score in the 80s is a B and a score in the 70s is a C.

Los Angeles inspectors make one to three unannounced visits every year. The riskier places — those with complex operations or those with bad reports in the past — get the most visits.

Scores may vary from one visit to another and even one inspector to another. A study of 190 Tennessee inspectors who had each performed at least 100 inspections in the late 1990s suggests that some are much more lenient than others. The average score handed out by one inspector was a 92 out of 100, which would translate to an A on a letter grading system. Another inspector averaged a 69, which is a D.

Though health grades are imperfect, they have definitely led to cleaner restaurants and healthier customers, says Dr. Jonathan Fielding, professor of health services and pediatrics at UCLA and the director of public health for Los Angeles County who helped create the current inspection system in L.A. When the county started its letter grading system in 1998, “restaurants changed their practices,” he says.

A 2005 study by Fielding and colleagues published in the Journal of Environmental Health found that the number of people in the county who were hospitalized with foodborne illnesses declined 13% in the year after the grading system was introduced.

Fielding acknowledges that inspectors can’t check to make sure that every employee carefully washes his or her hands. “We’re not going to stick cameras in the bathrooms.” But he also notes that the department often cites restaurants for not having any soap near the sinks or not giving employees easy access to a restroom. “You’d be surprised how often those are blocked off,” he adds.


You take a small risk every time you eat out, Binkley says (though she thinks it’s a risk worth taking). She’s not a professional restaurant inspector, but she definitely gives a place a look-over before she’ll place an order. “If the front of the restaurant is dirty, the kitchen is going to be even dirtier,” she says.

Big, fancy restaurants tend to take cleanliness especially seriously, but Binkley says she still enjoys eating at little hole-in-the-wall places, as long as they score better than a C. “It’s like eating raw oysters,” not necessarily 100% safe, but often delicious.

Even a famous name or a pricey menu is no guarantee of cleanliness. According to the L.A. Department of Public Health database, a May 11 inspection of Spago in Beverly Hills uncovered six minor violations, including unclean wiping cloths and improper storage. The restaurant scored a 91 out of 100. Still an A, but barely.

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