OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the licensee failed to ensure adequate administrative oversight of facility operations for food services. Findings include, but are not limited to: During the first revisit of the kitchen inspection of 02/11/25, conducted 04/30/25, administrative oversight to ensure adequate food services rendered in the facility was found to be ineffective based on failure to implement plan of correction and ensure adequate oversight to correct deficiencies. Refer to deficiencies in the report.

Co240: A) what will be fixed about this problem is a new cleaning chart. A new updated cleaning chart will be placed starting today, May 23rd 2025. This will indicate scrubbing the floor with a scrubby broom instead of a mop head every night, every day. Walls above the fridges and freezer including the vents will be a monthly cleaning with the help of maintenance. They will take them down wash and scrubb them and painted if needed, as I, food director, will dust around walls and corners Starting May 29th As of last week, 5-21-25, we changed our flour bin to the cambro bins which will be replaced everytime we restock and will be placed in dry storage. Black matter behind dishwasher will be resolved by scrubbing with limeaway and bleach to give it the white look starting Tuesday May 27th.

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. This Rule is not met as evidenced by:

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 ensure kitchen practices and protocols were in accordance with the Food Sanitation Rules OARs 333-150-0000. Findings include, but are not limited to: On 02/11/25 at 10:50 am, the facility kitchen was observed to need cleaning in the following areas: * Flooring throughout the kitchen, specifically underneath and behind equipment/storage shelves, corners, areas near walls (cove base), areas around counter legs and equipment wheels – food debris/significant black matter; * Ceiling vents and surrounding ceiling areas, including dry storage area, dishwashing area, food prep areas and refrigeration units – significant build up of dust; * Wall behind refrigeration units and sides of the units – significant build up of dust; * Bottom shelf of two door freezer – build up of food debris; * Wall behind stove – drips of grease; * Drain under two sink counter – significant build up of black matter; * Exterior of food bin storing flour – significant food debris; * Interior of microwaves in kitchen and two kitchenettes – food splatter; * Wall behind dishwasher, under sink and above back splash – significant build up of black matter; and * Lower shelf under stand mixer – food debris/crumbs on foil lined pans. Other areas of concern included: * Uncovered garbage when not in use; * Colored cutting boards with worn finishes (potentially uncleanable); and * Commercial can opener blade with finish worn off. The areas of concern were observed and discussed with Staff 1 (Food Service Director) and discussed with Staff 2 (Executive Director) on 02/11/25. The findings were acknowledged.

How I tend to correct this section is by: -Set a Monthly cleaning chart for maintnence to pressure wash our floors. We are mopping daily every night as it is in the daily check-off list. I myself or Whom the Diet aid or Executive Director, will be checking and making sure it is being done.(Will be completed 2/28/25) -We will also set a monthy checklist for Cleaning the ceiling vents and surrounding areas such as the dry storeage area, food prep area, and refridgerator area. Because of this issue there has been dust build upon the sides of the reachins. With this issue, I will be adding more to the weekly cleaning where cleaning the outside and wall areas are a must. Will be completed this weeks by (2/28/25). -We have a weekly deep cleaning list that says wiping down inside the 3 main reachins. We do this every week. I will be making sure it is being done and I will be the one who can mark off the checklist. (Will complete by Wednesday 2/26/25) -Our issue with wiping behind the stove walls, Cleaning the microwaves in kitchen and kitchennete and wiping under the mixer is on our Weekly Deep Cleaning checklist. We assign a section to a person and they get it done within that week period. What I will change is have a due date to make sure it is being done. (Complete by 2/28/25) -The drain under the 2-sink will be scrubbed once a month by myself to make sure we keep this up. I will use any cleaning chemical we have in out closet to use

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 ensure the kitchen was maintained in accordance with the Food Sanitation Rules OARs 333-150-0000. This is a repeat citation. Findings include, but are not limited to: On 04/30/25 at 1218 pm, the kitchen was toured and the following was observed: a. The following areas were in need of cleaning: * The flooring had black matter and food splashes/spills around the kitchen, especially under the dishwashing area and the double-sink area; * The walls above the refrigerators and freezers, the ceilings, and the ceiling vents had a buildup of dust; * The exterior of the food bin storing flour had a buildup of food splatters/debris; * The wall behind the dishwasher, under the sink, and above the backsplash had a buildup of black matter; and * The walls and shelves in the dry storage area had food splashes. b. The following areas were in need of repair: * There was broken flooring material in the corner of the wall where the small desk/chair was; * A triangle-shaped piece of flooring was missing and the flooring was cracked at the wall joint to the left of the mop sink; * A section of wall between the refrigerator and the double-sink area had chipped paint, missing drywall, and missing baseboard material; * There was a gouge in the wall to the left of the dishwashing sink near a bottle of multisurface disinfectant; and * The walls around the mop sink had peeling paint and were chipped, the faucets were rusted, and the wall around the faucet appeared bubbled with water damage. During an interview at 12:18 pm on 04/30/25, Staff 1 (Food Director) stated she was the only staff in the kitchen available for cleaning. She stated she tried to maintain a log with weekly tasks but often fell behind due to other duties, and she couldn’t reach the upper walls and ceilings. She stated there was a maintenance staff responsible for completing kitchen repairs, but he “was usually at [another building] instead of here.” She confirmed there was no other staff assisting with kitchen cleaning or maintenance. The areas needing cleaning and repair were toured with Staff 3 (ED) on 04/30/25. She acknowledged the findings.

Walls and shelves in dry storage was resolved by a new check out list both morning and night shift checks off at the end of there shift. check list if needed. Director will be more sturn on making sure they are doing there job well done. Walls in mop area will be resoulved by patching chipped piaint, whole and patched up with PVC panels. Pipes will be scrubbed and polish with a rust cleaner provided by maintetence starting Wednesday May 28th. All walls and corners with chipped paint, peeling paint and/or water damage will be resolved by patching and new paint on a day where both maintenance and food directorcan both work together done by the end of the month.

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 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Department. Findings include but are not limited to: Refer to C240.

Damaged floor will be fixed and patched like new. We will start every other month bringing in someone perfesaional to do a deep cleaning, wax and pollish corners and along the base board and in corners we cant reach starting sometime next week/end of month.

OAR 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation. 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 observation and interview, 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.

and bleach it so it shines. (Will be completed be Wednesday 2/26/25.) -Food Bins will be replaced with a new bin since we have lost the lid to one them with a better storeage so no debris can enter the bin. -Black debris around the dishwasher areas will be handled by adding to the daily cleaning checklist. We will be scrubbing all walls and backsplashes every shift. We will also be wipping under the sink to make sure no build up lingers. Will be completed 2/28/25 -We will be getting a new garbage can with a lid to replace our other one that’s by the coffee station. -Colored cutting boards have been replaced with newer ones. Alread completed on 2/20/25 -Commercial can opener, I have ordered a new one and will be replaced immediatley. (Being delivered as we speak. Delivery arrival is 2/27/25) For Z142 - Refer to 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: 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 240.

Refer to 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: