The unique aspects of a hospital environment, such as the multitude of dietary needs and thus the variety of meals to be served and incoming (raw) materials to be used, challenge the development and application of appropriate control and assurance measures to guarantee food safety. Besides, Listeria monocytogenes is considered a risk for most food service operations producing and serving ready-to-eat foods. Therefore the food safety management system of a hospital food service operation has been evaluated toward L. monocytogenes with an extensive questionnaire in the preset of this case study. In addition, 49 samples of food products and 145 environmental samples were taken and analyzed for L. monocytogenes to verify the implemented control measures. From this case study, it becomes clear that incoming (raw) materials, produced final products and their immediate supply to patients/consumers are high risk situations. This was demonstrated by the presence of L. monocytogenes in six incoming (raw) materials (n = 19) and one final product (n = 9). These risky situations are in need to be mitigated by the implementation of proper control measures, e.g. intensified supplier control, low storage temperatures, cleaning and disinfection to control cross-contamination. However major improvements can be made on the hygienic design of equipment and facilities and on the level of the sampling design. In terms of assurance activities, such as setting up a sampling plan, only a basic level was obtained for the validation and verification of their food safety management system. This case study illustrates that the combination of data from the questionnaire together with data of the sampling result in an overview on the performance of the current food safety management system and that major non-compliances and possibilities for improvement in the system can be defined. •Questionnaire gives insight on functionality of control and assurance activities.•Sampling plan sets priorities in selecting food products for analysis.•Presence of Listeria monocytogenes in raw materials needs follow-up actions.•Current verification activities need to be improved.