The findings of the kitchen inspection, conducted on 06/21/23, are documented in this report. The survey was conducted to determine compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services - Meals and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

The findings of the first re-visit to the kitchen re-licensure survey of 06/21/23, conducted 08/24/23, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services- Meals, and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

Based on observation and interview, it was determined the facility failed to ensure the kitchen was clean, protocols and practices were in accordance with the Food Sanitation Rules OARs 333-150-0000.

Findings include, but are not limited to:

On 06/21/23 at 11:15 am, the facility kitchen was observed to need cleaning in the following areas:

a. Food spills, splatters, debris and/or black/brown matter was observed on or underneath the following:

* Lower shelves throughout the kitchen including below the toaster, steam table, steamer and shelf storing pots and pans;

* Equipment included:

 - Doors on reach in refrigerator;

 - Small refrigerator doors near steam table;

 - Oven doors;

 - End of the steam table;

 - Rolling cart shelves;

 - Wall behind the stove/grill;

 - Convection oven doors;

 - Lid on bin holding oatmeal;

 - Ceiling above steam table;

 - The lid to the oatmeal bin, behind the mixer;

 - Light fixture near back door; and

 - Flooring throughout kitchen and underneath equipment.

Two garbage cans were uncovered when not in use near the ice machine and the dishwashing area.  

Improper food storage:

* Uncovered/undated items in walk in refrigerator including:

 - Two baked pies;

 - Tray of individual portions of pudding;

* Undated items included:

 - Ham, chopped salad and croissant sandwich;

* Bag of onions sitting on the floor in dry storage area;

* A sheet pan of cookies on rolling cart (next to steam table) were uncovered;

* Scoops/cups were stored in granulated sugar storage bin and three containers of cereal; and

* A stack of three boxes and a single box of food were sitting directly on the floor in freezer.

b. One staff not wearing beard restraint.

c. Uncovered individual servings of pudding on top of cart with trays delivered to the Memory Care Community unit dining room.

The areas of concern were discussed with Staff 1 (Dining Services Director) and Staff 2 (Executive Director) on 06/21/23. The findings were acknowledged.

-Food spills, splatters, debris and/or

black/brown matter was observed on or

underneath the following:

* Lower shelves throughout the kitchen

including below the toaster, steam table,

steamer and shelf storing pots and pans

* Equipment included:

 - Doors on reach in refrigerator

 - Small refrigerator doors near steam

table

 - Oven doors

 - End of the steam table

 - Rolling cart shelves

 - Wall behind the stove/grill

- Convection oven doors

 - Lid on bin holding oatmeal

 - Ceiling above steam table

 - The lid to the oatmeal bin, behind the

mixer

 - Light fixture near back door

 - Flooring throughout kitchen and

underneath equipment.

A deep clean of the kitchen will be performed and will include but not be limited to the lower shelves throughout the kitchen, including below the toaster, steam table, steamer and shelf storing pots and pans, doors on reach in refrigerators, small refrigerator doors near steam

table, oven doors, end of the steam table, rolling cart shelves, thaw wall behind the stove/grill, convection oven doors, lid on bin holding oatmeal, ceiling above steam table, the lid to the oatmeal bin, behind the mixer, light fixture near back door, and the flooring throughout kitchen/underneath equipment. A cleaning task sheet will be posted and followed to ensure continuous cleaning of the kitchen. The ED/designee will be responsible for ensuring compliance.

-Two garbage cans were uncovered when not in use near the ice machine and the dishwashing area.

All trash cans now have lids, staff will be educated on using lids on trash cans at July All Staff Meeting. The ED/designee will be responsible for ensuring compliance.

-Improper food storage was found by uncovered/undated items in walk in refrigerator, a bag of onions sitting on the floor in dry storage area, a sheet pan of cookies on rolling cart (next to steam table) were uncovered, scoops/cups were stored in granulated sugar storage bin and three containers of cereal, and a stack of three boxes and a single box of food were sitting directly on the floor in freezer.

All food that was improperly stored has been discarded, kitchen staff retrained on proper food storage to ensure food safety protocols are met. ED/Designee will be responsible for ensuring compliance.

-One staff not wearing beard restraint

Staff members were retrained on protocols for retraining hair and facial hair, beard restraints are available to staff. ED/designee responsible for ensuring compliance.

Uncovered individual servings of pudding on top of cart with trays delivered to the Memory Care Community unit dining room

Staff members retrained on expectation and importance of covering all food prior to being brought out of the kitchen/dining room. ED/designee reposinsible to ensure compliance.

Based on observation and interview, it was determined the facility failed to follow licensing rules of Residential Care and Assisted Living Facilities.

Findings include, but are not limited to:

Refer to C 240.

see C240