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, record review and interview, it was determined the facility failed to maintain the kitchen and food storage areas in good repair and in a sanitary manner in accordance with Food Sanitation Rules, OAR 333-150-000. Facility dedicated Person In Charge, did not demonstrate adequate knowledge of areas outlined in Food Sanitation Rules. Findings include, but are not limited to: Observation of the house kitchen on 04/22/25 from 11:40 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: * Reach in refrigerators and freezers * Drawers and cupboards * Range top burners * Hot pads and mitts * Exterior of Ninja blender * Toaster * Thermometer probe; and * Drawer under oven where pan lids were stored. b. The following areas needed repair: * Drawer under oven * Multiple sections in garage area next to food storage closet with drywall missing exposing holes to walls. c. Multiple cans in dry goods storage were noted dented/damaged. d. Multiple potentially hazardous food items were observed stored in both house refrigerators that were not dated when opened as required. e. Multiple items were observed stored on the floor in garage panty. f. Multiple items were found stored in dry goods cupboard that were open to potential contamination. g. Multiple care staff were observed to be assisting residents with meal and or in and out of the kitchen area for food related tasks without aprons/protective barrier to prevent possible contamination. h. No strips to check or verify sanitizing solutions were at correct levels were located. Staff 2 (person in charge) was not aware of what strips were utilized. When interviewed about surface sanitation a spray Lysol product was used. Staff indicated they sprayed the counter top then whipped with a towel. No contact time was utilized or disclosed. Upon reading directions on the spray container it was a 10 min contact time and the product was to be wiped/rinsed off with water. The facility also had a product that was used that did not require a rinse but did require a mix to a correct parts per million concentration, however no test strips were available. Staff 2 did not know what strips would need to be utilized. i. Staff member was observed to enter the kitchen area from a care area. Staff did not don an apron and did not wash their hands. That staff then opened the refrigerator and retrieved an item and went to residents seated at the dining room table. Staff then went back to kitchen are and back into the refrigerator without washing hands. j. Food thermometer was observed stored in a drawer by the stove. The probe was uncovered and was observed with dried food debris. No method was available to sanitize the probe before/between/after use as required. k. Staff 2 (dedicated person in charge) was interviewed and was not able to correctly demonstrate the following *Correct cook to temperatures for multiple meat products *Propper reheat temperature *Potentially hazardous foods *Illnesses per food code that require exclusion and reporting *Effective surface sanitizing process l. Trash can was observed uncovered and filled with food products with out a lid when not in use. m. Facility did not have a copy of the current food code for PIC or staff with food preparation duties to refer to as required. Staff 1 (Executive director) was not aware of the Food Sanitation Rules document and surveyor assisted the facility in locating and printing a copy for staff reference. n. At 1:00 pm, Staff 2 was interviewed. They were not able to demonstrate effective knowledge in final cook to temperatures for all meat/protein items. They were also not able to discus proper thawing practices, proper cooling time/temperature benchmarks and methods. The PIC did not demonstrate effective oversight for cold food storage with 3 of 4 refrigerators not storing food at appropriate temperatures. The facility did not have effective ware washing sanitation practices and oversight. Staff 2 (PIC) toured areas with surveyor and acknowledged areas in need of attention and correction. In an interview on at 2 pm, Staff 1 (Executive Director) and Staff 3 (Assistant Executive Director) were informed of concerns found and acknowledged areas needing correction.

Hawthorne House will implement the following below: 1. A. All areas noted with accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter, and grease will be deep cleaned. B. All areas needing repaired will be repaired. C. All cans in dry storage with dents or that was damaged have been removed. D. All food items in refrigerators have been dated and labeled. E. All items that were stored on floor in garage pantry have been removed. F. All items have been removed from the dry goods cupboard that could potentially contaminate any food. G. All staff have been retrained on when to wear aprons/protective barriers to prevent possible contamination. H. All staff have been retrained on how and what to use to clean and sanitize all surfaces. All staff have been retrained on universal precautions, wearing aprons and performing hand hygiene. J. Staff all retrained on cleaning and sanitizing the food thermometer probe before, between and after use as required. K. All staff have been retrained on all the below *Correct cook-to temperatures for multiple meat products; *Proper reheat temperatures; *Potentially hazardous foods; *Illnesses per food code that require exclusion and reporting; and *Effective surface sanitizing process. L. A new trash can with a lid has been purchased. M. Food sanitation Rules have printed, Labeled and available for all staff, all retrained on reading and using it. N. All staff have been retrained on effective warewashing and sanitation practices and oversight. 2. All the above noted areas will be corrected by retraining all staff, having task sheets and material printed available for all staff at all times., and going over Kitchen Sanitation at monthly staff meetings. 3. The areas will be evaluated at least three times a week. 4. The Executive Director and Assistant will be responsible to be sure all corrections are completed and monitored.

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.

Please refer to C0240

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: