OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). This Rule is not met as evidenced by: Based on observation, and interview, it was determined the facility failed to maintain the kitchen in good repair and in a sanitary manner in accordance with Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: Observation of the main facility kitchen and food storage areas on 10/18/24 from 10:45 am thru 2:15 pm revealed the following deficient practices. a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter and grease was visible on or underneath the following: * Floor under/behind and between major equipment; * Floor under and around ware washing area; * Kitchen drains near/around ware washing area; * Clean area of dish washing area with visible food debris; * Wire spice rack; * Industrial Mixer; * Reach in freezer; * Ceiling vents and sprinkler heads; * Floor in dry storage room; * Shelving in dry storage; * Window ledges and screens around kitchen, * Stainless steel counter top where steam wells stored; * Can opener/housing; and * Interior of microwave. b. The following areas needed repair: * Holes by electrical conduit by stove hood. c. Multiple dishwashing racks observed stored on the floor. d. Multiple dietary employees were handling clean dishes, serving residents food, and/or preparing food without facial hair restraints. e. Multiple potentially hazardous food items were observed in cold food storage areas without open dates and/or without use by dates. f. Reach in refrigerator in dry storage observed without thermometer to accurately monitor cold food storage temperature. Staff 2 (Kitchen Manager) verified food stored in that fridge was for resident consumption. g. Facility did not have test strips to check surface sanitizer solution concentration to ensure sanitizer dispensing at correct parts per million (PPM). h. Dry food storage was located in same location as activity supply storage causing potential cross contamination of food items. Single service cups/utensils stored open to potential contamination. i. Pureed food items were left uncovered during extended time frames during preparation and staff did not ensure those products were held hot until served. Process to mechanicalize/puree food products took an extended amount of time (greater than 30 minutes). Staff 2 acknowledged extended service times for mechanical soft and puree items and always waited to the end of service for these residents. Facility had 3 residents with puree texture and 1 small capacity food processor. Surveyor observed need to puree multiple batches of all food items in order to produce the 3 servings extending the preparation time. Staff 2 and other dietary staff were unsure of appropriate texture for puree stating not much education/training was provided. Surveyor ensured pureed items were at correct texture prior to service to residents and provided staff with spoon flick and fork test procedures per IDDSI guidelines for future use. j. Staff 2 was not able to adequately demonstrate appropriate knowledge of food worker illnesses for exclusion, proper reheat temperatures, nor correct cooling processes. Staff 2 did not have access to Oregon food sanitation rules. k. Menu items for lunch was Baked fish, baked potato, and mixed vegetables. Alternate item was Swedish meatballs. Several servings of alternate were served to residents with solely a bowl of meatballs. No starch or vegetable was offered with alternative for a complete meal. Staff 2 (Kitchen manager) toured with surveyor and acknowledged areas in need of cleaning and attention. In a phone interview on 10/21/24 at 11:15 am, Staff 1 (Executive director) was informed of concerns found and acknowledged areas needing correction.

1. The kitchen manager has worked on basic cleanliness addressing the issues identified in section a: food spills, loose food and trash debris, dirt, dust, black matter and grease; Section b: holes by electrical conduits are scheduled to be fixed; Section c: dishwasher racks are no longer being stored on the floor; Section d: hair nets/restraints have been ordered; Section e: kitchen manager has labeled and dated items; Section f: thermometers have been ordered; Section g: sanitizer test strips have been ordered ; Section h: dry storage items have been secured; Section i: diet orders have been reviewed with staff and the kitchen is obtaining a larger food processor to ensure timely provision of mechanically altered meals; Section j: kitchen staff have access to food sanitation rules. Section k: kitchen manager is ensuring appropriate amounts of food are being prepared to ensure each resident gets a full meal. 2. The kitchen manager is developing a daily, weekly and monthly cleaning schedule. The kicthen manager and the administrator to complete a weekly walk-through looking at kitchen cleanliness, organization and needed repairs. All kitchen staff to be in-serviced on infection control measures including and not limited to: hair restraints, the use of test strips for sanitation bucket testing, safe food handling. Food handler's cards will be obtained for all employees requiring cards. All diet orders will be confirmed and the kitchen will have a list of diet orders for each resident that is to remain current. All staff will be trained on the importance of following diet orders. The kitchen manager is developing a par list to determine proper amounts of food to order and prepare to ensure the kitchen does not run out of food. 3. The systems will be reviewed weekly during kitchen audits and walk-throughs, and monthly in the Quality Improvement Meeting. 4. Kitchen Manager and Administrator.

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). This Rule is not met as evidenced by:

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 observations and interviews, 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 C240.

See Plan of Correction for C240.

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: