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: The facility’s kitchen was toured on 06/17/25 at 10:10 am. The following was identified: a. An accumulation of food spills, splatters, loose food debris, grease, dirt, dust, garbage, or black matter was observed on, in or underneath the following: * Floor and baseboard junctions throughout the kitchen; * Walls behind appliances and sinks throughout the kitchen; * Gas pipes to the stove and griddle; * Water pipes to the warewasher and ice maker; * Floor drains; * Floors underneath storage racks in the walk-in refrigerator; * Ceiling vent above the juice machine; * Hood above the warewasher; * Interior casing of the can opener; * Plastic shavings were piled below cutting board racks where boards had scraped against metal dividers as they were removed; * Inside the ice maker along the cartridge that dispenses ice; and * Rust and corrosion were noted on floating ceiling tile supports, lighting fixtures and vents around the warewasher and three-compartment sink, as well as the ceiling seams in the walk-in refrigerator. b. The following kitchen items required repair or replacement: * Hole in the wall underneath warewasher; * Cut-out in the drywall in the janitor’s closet exposed water shut-off valves, pipes and insulation; * Broken drain for the cold prep sink; * Rusted drain under the three-compartment sink; * Rusted metal access panel under the three-compartment sink with splitting tile mortar around the panel interface; * Gap along the bottom edge of the exterior door could allow entry of insects and pests; * Drywall and corners in the dry food storage room were gouged and scratched; * Cabinet doors on the service line and coffee/juice stations did not close; * Floors in dining room cabinet that supported the soda dispenser were either missing or sagging and were stained and/or coated with black matter; * Cabinetry under the coffee/juice station had worn corners and laminate panels, exposing bare wood; * Ladder in dry storage room was heavily coated with dried paint and stains; and * Handwashing sink in cold prep room did not have a splash guard between it and the adjacent prep table. c. Poor infection control practices observed, but not limited to: * Stand mixer and mixing bowl were left uncovered when not in use; * Kitchen staff did not have access to chemical testing strips; * Kitchen staff failed to perform hand hygiene consistently between clean and dirty tasks; and * Silverware on preset dining tables was not covered. A kitchen walkthrough was completed with Staff 1 (ED) and Staff 2 (Administrator) on 06/17/25 at 12:37 pm. The areas that did not meet the rules were discussed with Staff 1 and Staff 2. They acknowledged the findings.

6/24/2025 a deep clean of the kitchen began, cleaning baseboards, walls behind appliances, gas pipes to stove and griddle, floors, floor drains, and vents. Maintenance notifed of all respairs needed. Chemical testing strips have been ordered, staff educated on importance of hand hygiene (Basics of Hand Hygiene - Relias). Plan in place with maintenance on schedule of repairs- hole under warewasher will be covered, plastic cover will be placed over shut off valves in janitors closet, repair and clean drains with porcelain repair kit, repair/replace metal access panel and splitting tile mortar, patch and paint dry food storage room, repair cabinet doors worn corners, and laminate panels on cabinetry, replace ladder, attach rubber strip to exterior door to seal gap, repair/replace floors in dining room cabinets, mixing bowl to be stored upside down, replace worn cutting boards. When presetting tables, napkin will be placed over the silverware rather than under, install splash guard between prep table and sink. Training and oversight of staff on routine daily, weekly, and monthly cleaning schedules. Quarterly walk through by safety committee. Education on glove usage to be done annually and as needed per routine audits. Daily, weekly, and monthly per audits and kitchen walk through. Executive Chef and Executive Director

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:

7/31/25, Dietary manager completed a deep clean of the kitchen to remove food spills, splatters, loose food and trash debris, dirt, dust, black matter and grease. 7/31/25 The stand mixer is now covered when not in use. 09/05/2025 Maintenance assistant cleaned and removed the rust and corrosion on the floating ceiling tile supports, and on 9/9/25 the rust was cleaned from the 3 compartment sink, and interior dining room cabinet. On 9/5/25 Rust colored drains under the three compartment sink, and three other drains were cleaned, and painted. The cabinet that supports the soda dispenserwas fixed and missing pieces were replaced and sealed. On 9/5/25 the shut off valves/pipes now have a cover. 9/9/25 the hole in wall by dishwasher is covered. 9/5/25 The facility is working on removing the cabinetry under the coffee/juice station. Replacing the countertops and other areas with exposed wood. This will be completed by the end of September 2025. Dietary manager or designee will conduct daily audits to enausre kitchen cleaniness and that the mixer is covered. Dietary manager or designee will conduct semi monthly audits to ensure cabinets are in good standing with no broken or exposed areas, and there are no open holes or exposed areas in the kitchen,

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 a sanitary manner and ensure food was prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). This is a repeat citation. Findings include, but are not limited to: On 08/26/25, from 12:04 pm to 1:37 pm, interviews with staff and observations of the facility kitchen, food storage areas, food preparation, and food service were conducted. The following was identified: 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: * Four floor drains located throughout the kitchen; * Rust and corrosion were noted on floating ceiling tile supports around the ware washer and three-compartment sink; and * The interior of the dining room cabinet that supported the soda dispenser. b. The following areas were noted in need of repair: * Hole in the wall underneath ware washer; * Cut-out in the drywall in the janitor’s closet exposed water shut-off valves, pipes and insulation; * Rust colored drain under the three-compartment sink; * Rust colored metal access panel under the three-compartment sink with splitting tile mortar around the panel interface; * The interior and exterior of the dining room cabinet that supported the soda dispenser had missing and broken material and had unsealed wood that supported the base of the cabinet; and * Cabinetry under the coffee/juice station had worn corners and laminate panels, exposing bare wood. c. Stand mixer and mixing bowl were left uncovered when not in use. On 08/26/25 at 1:24 pm, Staff 1 (Executive Director), and Staff 2 (Memory Care Administrator), Staff 3 (Executive Chef), and Staff 4 (Maintenance Supervisor), completed a walk-through of the kitchen with this surveyor and reviewed the above noted areas. The need to ensure the kitchen was maintained in a sanitary manner and food was prepared and served in accordance with Food Sanitation Rules was reviewed with Staff 1, Staff 2, Staff 3, and Staff 4 on 08/26/25 at 1:28 pm. They acknowledged the findings.

7/31/25, Dietary manager completed a deep clean of the kitchen to remove food spills, splatters, loose food and trash debris, dirt, dust, black matter and grease. 7/31/25 The stand mixer is now covered when not in use. 09/05/2025 Maintenance assistant cleaned and removed the rust and corrosion on the floating ceiling tile supports, and on 9/9/25 the rust was cleaned from the 3 compartment sink, and interior dining room cabinet. On 9/5/25 Rust colored drains under the three compartment sink, and three other drains were cleaned, and painted. The cabinet that supports the soda dispenserwas fixed and missing pieces were replaced and sealed. On 9/5/25 the shut off valves/pipes now have a cover. 9/9/25 the hole in wall by dishwasher is covered. 9/5/25 The facility is working on removing the cabinetry under the coffee/juice station. Replacing the countertops and other areas with exposed wood. This will be completed by the end of September 2025. Dietary manager or designee will conduct daily audits to enausre kitchen cleaniness and that the mixer is covered. Dietary manager or designee will conduct semi monthly audits to ensure cabinets are in good standing with no broken or exposed areas, and there are no open holes or exposed areas in the kitchen,

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 and interview, it was determined the facility failed to ensure their kitchen re-licensure survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to: Refer to C240.

Administrator or designee will complete audits of kitchen survey and ensure that facility is in compliance by date provided. Audits will be conducted during and after survey. Administrator and or designee will hold department managers accountable for ensuring that compliance is reached by date.

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: