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 occurred on 04/16/25 from 10:45 am thru 1:30 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: * Pipes, drain, walls and flooring behind/underneath of the dish machine. * Kitchen drains. * Flooring in corners, edges, under and between equipment. * Industrial mixer. * Exterior of soup kettle. * Walk in cooler floors under racks. * Walk in freezer floors. * Walk in cooler stationary racks. * Tall movable metal rack located in walk in cooler. * Open shelving under steam line. * Black utility carts. * Insulated food transportation carts. * Light fixtures * Sprinkler heads. * Cabinet under sink by beverage service station. * Flooring between steam line and ovens. * Stove top and grill top. b. The following areas needed repair: * Large gap/hole in wall where gas line inters/exits wall next/near large industrial mixer * Reach in cooler with broken/cracked door seal. * Multiple areas in ceiling where paint/ceiling pealed/chipped or damaged. * Two small holes in ceiling * Wall in dry storage with damage behind racks * Right oven damaged and didn’t work * Steamer not operational. * Sections of tile flooring missing grout * Section of shelving in janitor closet area with porous wood. c. Both sanitizer buckets found with zero parts per million of sanitizing agent. Staff was not sure when the bucket was last made. Both containers of strips were noted to be expired as of Jan 1 2019. d. Staff 2 (Dining Services Manager) was observed to serve cooked to order grilled hamburgers without checking that the temperature of the food product was safe or palatable. e. Facility did not have a thin prob diameter thermometer probe available for checking temperatures of thin foods. f. Multiple food contact surfaces of single use plates, etc were noted stored open to potential contamination. g. Staff 1 was noted to not change gloves after handling potential contaminated items before touching ready to eat food products. h. Dish washing racks were observed stored on the floor. i. Multiple cutting boards were observed damaged/stained or heavily scored and in need of replacement. j. The main dining room was noted to have silverware for the Noon meal set on tables at 10:45am and were not covered or inverted as required. On 04/16/25 at 1:15 pm, staff 1 (Executive director) was interviewed and acknowledged the above areas in need of correction.

C240 A1-All arears noted to be out of compliance have been cleaned * Pipes, drain, walls and flooring behind/underneath of the dish machine. * Kitchen drains. * Flooring in corners, edges, under and between equipment. * Industrial mixer. * Exterior of soup kettle. * Walk in cooler floors under racks. * Walk in freezer floors. * Walk in cooler stationary racks. * Tall movable metal rack located in walk in cooler. * Open shelving under steam line. * Black utility carts. * Insulated food transportation carts. * Light fixtures * Sprinkler heads. * Cabinet under sink by beverage service station. * Flooring between steam line and ovens. * Stove top and grill top. * Interior of oven in MCC unit * Interior of reach in refrigerator on unit. * Interior of cabinets and drawers in kitchenette . A2-Daily cleaning logs are in place to ensure compliace. A3-Cleaning will take place daily per cleaning task list. A4-DSM/or designee will monitor and ensure compliance. B1-All findings listed have been corrected. * Large gap/hole in wall where gas line enters/exits wall near large industrial mixer. * Reach in cooler with broken/cracked door seal. * Multiple areas in ceiling where paint/ceiling peeled/chipped or damaged. * Two small holes in ceiling. * Wall in dry storage with damage behind racks. * Right oven damaged and didn’t work. * Steamer not operational. * Sections of tile flooring missing grout. * Section of shelving in janitor closet area with porous wood. * Oven door in kitchenette was damaged and not closing smoothly/currently. B2-DSM, maintenance or designee will report and have any areas out of compliance corrected upon discovery. B3-Kitchenwill be evaluated daily and as needed B-4DSM/maintenance or designee. C1-Sanitizing strips have been purchased. Both sanitizer buckets found with zero parts per million of sanitizing agent. Staff was not sure when the sanitizer was last made. Both containers of strips were noted to be expired as of Jan 1, 2019. C2-During weekly order, DSM or designee will ensure strips are available and not expired and order as needed. C3-Weekly C4-DSM or designee D/E1-Thin diameter thermometers have been purchased. (Dining Services Manager) was observed to serve cooked to order grilled hamburgers without checking that the temperature of the food product was safe or palatable. D2-DSM has had additional training to ensure safe food handling practices are observed and maintained. D3-Food temp log is in place and will be maintained for safety compliance. D4-DSM or designee F1-Single use products have been covered. Multiple food contact surfaces of single use plates, etc. were noted stored open to potential contamination. F2-Single use products will remainin packaging, covered or stored appropriatly. F3-Daily F4-DSM/or designee G1-Staff 1 has been retrained on food safety/handeling and cross contamination. Staff 1 was noted to not change gloves after handling potential contaminated items before touching ready to eat food products. G2-Food safety protocols will be followed and maintained. G3-As needed G4-ED or designee H-Dish washing racks were observed stored on the floor. H1-Dish racks will be stored off the floor. H2-Dish racks will remain off the floor while not in use. H3-Daily and as needed H4-DSM or designee I1-Cutting boards have been replaced Multiple cutting boards were observed damaged/stained or heavily scored and in need of replacement I2-New boards will be purchased as needed. I3-Daily I4-DSM or designee J1-Training has been complete with all staff on table set-up. The dining room was noted to have silverware for the noon meal set on tables at 10:45 am and were not covered or inverted as required J2-On going staff training will be complete t ensure compliance. J3-Daily J4-DSM or designee

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. This is a repeat citation. Findings include, but are not limited to: Observation of the main facility kitchen occurred on 6/17/25 from 11:08 am through 3:00 pm revealed the following: 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: * Pipes, drain, walls and flooring above the sink and behind/underneath of the dishwashing area and dish machine; * Flooring in corners, edges, under and between equipment; * Industrial mixer; * Walk in cooler floors under racks; * Walk in cooler stationary racks; * Tall movable metal rack located in walk in cooler; * Walk in freezer floors; * Insulated food transportation carts; * Cabinet under sink by beverage service station; * Flooring between steam line and ovens; * Stove top and grill top; and * Inside of steamer. b. The following areas needed repair: * Active leak under the sink in the dishwashing area; * Large gap/hole in wall where gas line enters/exits wall next/near large industrial mixer; * Walk-in cooler with broken door handle and door not sealing properly; * Left side of oven not heating food evenly; * Steamer not operational; and * Section of shelving in janitor closet area with porous wood. c. Multiple items in the walk-in freezer were open and uncovered. d. Multiple items in the walk-in cooler were not dated/labeled as required. The need to ensure the facility maintained the kitchen in good repair and in a sanitary manner in accordance with Food Sanitation Rules, OAR 333-150-000, was reviewed with Staff 1 (ED) and Staff 3 (ED in training) on 06/17/25 at 3:15 pm. They acknowledged the findings.

1.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: * Pipes, drain, walls and flooring above the sink and behind/underneath of the dishwashing area and dish machine; * Flooring in corners, edges, under and betweenequipment; * Industrial mixer; * Walk in cooler floors under racks; * Walk in cooler stationary racks; * Tall movable metal rack located in walk in cooler; * Walk in freezer floors; * Insulated food transportation carts; * Cabinet under sink by beverage service station; * Flooring between steam line and ovens; * Stove top and grill top; and * Inside of steamer. 1A. All areas have been cleaned and are in compliance. 1A. Cleaning tools have been implemented to ensure corrections. Elderwise is in house for training 1A. Cook/DSM or designee will evaluate daily for compliance. 1A. DSM/designee b. The following areas needed repair:REPAIRED * Active leak under the sink in the dishwashing area; * Large gap/hole in wall where gas line enters/exits wall next/near large industrial mixer; REPAIRED* Walk-in cooler with broken door handle and door not sealing properly; *REPAIRED Left side of oven not heating food evenly; *REPAIRED Steamer not operational; and * Section of shelving in janitor closet area with porous wood. REPAIRED Multiple items in the walk-in freezer were open and uncovered. d. ALL ITEMS LABELED/DATED Multiple items in the walk-in cooler were not dated/labeled as required. 1B. All areas have been repaired 1B. All needed repairs will be added to the work order system upon being noted. 1B. Daily 1B. DSM/designee C1. All opened undated items have been removed C1. training has been complete with all staff C1. Cook/DSM or designee will monitor daily C1. Cook/DSM or designee D1. Cooler has been gone through ensuring all items ae dated/labeled D1. All staff have been trained on proper labeling and dates D1. Cook/DSM or designee will monitor daily for compliance D1. DSM/Cook or designee E1. Drawers have been cleared E1. MC staff have been directed where to store items not belonging in the kitchen. E1. LPN or designee will monitor daily E1. ED/LPN or designee F1. All items have been removed or dated F1. training omplete witth kitchen staff and MC staff F1. Cook/DSM or designee will monitor daily F1. Cook/DSM or designee

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 observation, interview and record review it was determined the facility failed to ensure their kitchen survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to: Refer to C 240.

Refer to C240.

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: