OAR 411-054-0070 (5 & 9-10) Training Within 30 Days of Hire – Direct Care Staff (5) TRAINING WITHIN 30 DAYS OF HIRE FOR DIRECT CARE STAFF. (a) The facility is responsible to verify that direct care staff have demonstrated satisfactory performance in any duty they are assigned. (b) Knowledge and performance must be demonstrated in all areas within the first 30 days of hire, including, but not limited to: (A) The role of service plans in providing individualized resident care. (B) Providing assistance with the activities of daily living. (C) Changes associated with normal aging. (D) Identification of changes in the resident's physical, emotional and mental functioning and documentation and reporting on the resident's changes of condition. (E) Conditions that require assessment, treatment, observation and reporting. (F) General food safety, serving and sanitation. (G) If the direct care staff person’s duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) must document that they have observed and evaluated the individual’s ability to perform safe medication and treatment administration unsupervised. (9) ADDITIONAL REQUIREMENTS. Staff: (a) Under 18 years of age may not perform medication administration or delegated nursing tasks. Staff under the age of 18 must be directly supervised when providing bathing, toileting, incontinence care or transferring services. (b) Must be trained in the use of the abdominal thrust and First Aid. Cardiopulmonary resuscitation (CPR) training is recommended, but not required. (c) Must have sufficient communication and language skills to enable them to perform their duties and communicate with residents, other staff, family members, and health care professionals, as needed. (10) Contractors who provide services or supports directly to residents must complete the required LGBTQIA2S+ trainings outlined in paragraph (6)(b)(C) of this rule. (a) Contractors who must be trained include, but are not limited to, RN and administrative consultants, housekeeping services, dietary services, beauticians, barbers, or other contractors who provide services or supports directly to residents. This Rule is not met as evidenced by: Based on record review and interview, it was determined the facility failed to ensure 1 of 2 sampled newly hired direct care staff (#6) completed abdominal thrust training within 30 days of hire. Findings include, but are not limited to: Staff training records were reviewed on 04/22/25. Staff 6 (Care Partner) hired 01/21/25, did not have documented evidence abdominal thrust training had been completed within 30 days of hire. The need to ensure staff completed all required training as specified in the OARs was discussed with Staff 1 (Memory Care Administrator) and Staff 5 (Business Office Manager) on 04/23/25. They acknowledged the findings.

1. Care Staff #6 was immediately trained on the missing abdominal thrust training. 2. Business office manager, Memory Care Administrato and Assisted Living Administrator edited and updated the internal training tracking tool to include a second and third (final) check to ensure that new staff members have completed all training prior to providing resident care. 3. The pre-service training will be audited once weekly for all newly hired staff for 4 weeks in a row then bi-weekly for two occurences, and then monthly thereafter during QA meetings. 4. The business office manager will complete weekly audits, and the memory care administrator will review and ensure that audit was completed on the timeline noted. Business office manager, Memory Care Administrator and Assisted Living Adminstrator will review monthly at QA Meetings.

OAR 411-057-0140(2) Administration Compliance (2) The licensee of a memory care community must comply with both the licensing rules for the facility and Chapter 411, Division 57. This Rule is not met as evidenced by: Based on observation, interview and record review, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to: Refer to C 372.

1. Refer to the plan of correction that is outlined under C372

OAR 411-057-0155(1-6) Staff Training Requirements (1) A memory care community must ensure staff who provide support to residents with dementia have a basic understanding and fundamental knowledge of the residents' emotional and unique health care needs prior to providing services to residents. The training requirements for staff who work in memory care communities are described in the following sections. (2) ALL STAFF TRAINING REQUIREMENTS. All staff who work in memory care communities licensed as residential care facilities or assisted living facilities must complete the following: (a) Orientation as required in OAR 411-054-0070(3) before performing any job duties. (b) Pre-service dementia care training as required before independently providing personal care or other services. The dementia care training must address these topics: (A) Education on the dementia disease process, including the progression of the disease, memory loss and psychiatric and behavioral symptoms. (B) Techniques for understanding, communicating and responding to distressful behavioral symptoms; including but not limited to, reducing the use of antipsychotic medications for non-standard uses when responding to distressful behavioral symptoms. (C) Strategies for addressing social needs of persons with dementia and engaging them with meaningful activities; (D) Information concerning specific aspects of dementia care and ensuring safety of residents with dementia including, but not limited to, how to: (i) Identify and address pain; (ii) Provide food and fluid; (iii) Prevent wandering and elopement; (iv) Use a person-centered approach. (c) Additional pre-service training topics that must be completed before independently providing personal care to residents: (A) Environmental factors that are important to resident ' s well-being (e.g. noise, staff interactions, lighting, room temperature, etc.); (B) Family support and the role the family may have in the care of the resident; (C) How to recognize behaviors that indicate a change in the resident ' s condition and report behaviors that require on-going assessment. (3) DIRECT CARE STAFF TRAINING REQUIREMENTS. Direct care staff must be directly supervised by a qualified staff person until they have successfully demonstrated satisfactory performance in any task assigned in the provision of individualized resident services. In addition to training required for all staff as described in paragraph (2): (a) Before independently providing personal care or other services to residents, direct care staff must complete training on: (A) How to provide personal care to a resident with dementia, including an orientation to the resident and the resident ' s service plan, as required in OAR 411-054-0070(4). (B) The use of supportive devices with restraining qualities in memory care communities. (b) Within 30 days after hire, direct care staff must complete training as outlined in OAR 411-054-0070(5). (c) Direct care staff who work in memory care communities licensed as residential care facilities or assisted living facilities must complete a total of 16 hours of in-service training annually. The six hours of annual dementia care training required pursuant to OAR 411-054-0070(6) may be included in the 16 hours of in-service training. Annual in-service hours required of each staff are due by the anniversary date of that person ' s hire. All completed trainings must be documented by the facility. (4) NURSING FACILITY STAFF. Staff who work in memory care communities licensed as nursing facilities must complete the following: (a) Orientation as outlined in OAR 411-086-0310, 42 CFR ? 483.95 (F 943). (b) Pre-service dementia care training as outlined in paragraphs (2)(b) and (c) and paragraph (3)(a) of this section. (c) A total of 16 hours of annual in-service training must be completed by direct care staff only. Four of the 16 hours must be dementia care training and may be included in the 16 hours of in-service training. Annual in-service hours required of each staff are due by the anniversary date of that person ' s hire. All completed trainings must be documented by the facility. (5) Persons providing or overseeing the training of staff must have experience and knowledge in the care of individuals with dementia. (6) The memory care community must have a method for determining and documenting each staff person ' s competency of training in accordance with the licensing rules. All training must be documented and available to the Department upon request. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure 2 of 2 newly hired staff (#s 6 and 7) completed additional pre-service dementia training prior to beginning their job responsibilities and 1 of 1 long term, non-direct care staff (#5) completed required annual infectious disease training. Findings include, but are not limited to: Staff training records were reviewed on 04/22/25. The following was identified: a. There was no documented evidence Staff 6 (Care Partner), hired 01/21/25, and Staff 7 (MT), hired 12/23/24, completed the following additional pre-service dementia training topics: * Environmental factors that are important to a resident’s well-being (e.g. staff interactions, lightening, room temperature, noise, etc.); * Family support and the role the family may have in the care of the resident; and * Use of supportive devices with restraining qualities in memory care communities. b. Staff 5 (Dining Services Director), hired 06/22/21 lacked documented evidence of completion of annual infectious disease training. The need to ensure all staff completed the additional pre-service dementia training, and completed required infectious disease training annually, was discussed with Staff 1 (Memory Care Administrator), and Staff 4 (Business Office Manager) on 04/23/25. They acknowledged the findings.

1. Staff members #6 and #7 completed additional training courses as listed. Staff member #5 completed infectious control training. 2. Business office manager, Memory Care Administrator and Assisted Living Administrator have edited and updated the pre-service checklist to include the additional memory care training noted: a. Use of supportive devices with restraining qualities in memory care communities. b. Family support and the role the family may have in the care of the resident. c. Environmental factors that are important to a resident’s well-being (e.g. staff interactions, lightening, room temperature, noise, etc.). The facility acknowledges that the infection control training was not completed by long term staff. This was a facility oversight. 3.The pre-service training will be audited once weekly for all newly hired staff for 4 weeks in a row then bi-monthly for two occurences, and then monthly thereafter during QA meetings. Long term staff training will be audited by 5/15/2025 and then monthly thereafter for required annual training. 4. The business office manager will complete weekly audits, and the memory care administrator will review and ensure that audit was completed on the timeline noted. Business office manager, Memory Care Administrator and Assisted Living Adminstrator will review monthly at QA Meetings.