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 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 the memory care kitchenette on 10/02/25 from 10:35 am thru 2:00 pm revealed the following deficient practices. 1. Main Kitchen 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. * Top of dish machine * Kitchen drains. * Interior of ice machine * Metal movable “speed” racks * Reach in cooler in beverage area * Interior of microwave in beverage/service area * Juice machine (by spouts) with splash accumulation * Open stainless steel shelving in front of line storing dishes * Industrial mixer. * Industrial can opener and housing * Ceiling vent covers above back food prep area * Stainless steel shelving where cutting boards were stored * Walk in cooler stationary and movable racks * Walk in cooler fan cages and ceiling * Flooring under racks in walk in cooler * Reach in deli cooler * Interior of ovens * Stainless Steel shelving above steam/service line * Flooring in janitor closet b. The following areas needed repair: * Caulking in dish washer area with black debris build up. * Visible leak in piping under garbage disposal with foul smelling standing water collecting in a plastic container under pipe. c. Thermometer in reach in cooler by service line noted at 50 degrees at 11:01am and was checked again at 12:45 pm and was also at or above 50 degrees. Staff 2 (Executive Chef) was immediately notified and asked to check the temperature of potentially hazardous food items stored within the reach in cooler. The following items were checked: Raw hamburger patty at 54 degrees, raw chicken breast at 52 degrees and raw fish fillet at 51 degrees. Surveyor had facility discard all PHF items found at above 41 degrees. Morning cook was interviewed and confirmed the cooler was noted by them at 53 degrees that morning. The cook indicated that refrigerator had been having issues with temping high during the afternoon/evening shift and then recovering once items were shifted around. Cook acknowledged they did not check the temperatures of the food items held/stored in that cooler when the temperatures were found above safe storage temperatures prior to service. Cook acknowledged they had not notified facility administration. Facility was asked to provide the temperature logs for the reach in cooler for the month of September. There 13 temperatures logged that were greater than 41 degrees (safe cold food storage temperature) and nine temperatures that were recorded at 50 degrees or higher. The highest reading was recorded at 58 degrees on 09/23/25. Staff 1 (Executive Director) was interviewed at 1:00pm and was notified of the concern with food storage temperatures. Staff 1 acknowledged they had not been notified of any issues with the reach in cooler holding temperatures. Staff 2 also indicated they were not aware of the ongoing temperature issues of that reach in cooler and that they would get a repair technician out to look at it right away. Surveyor validated that all potentially hazardous food items stored in that cooler were discarded for resident safety. d. Multiple food items were observed in reach in and walk in refrigerators without dates opened or dates prepared as required. e. Multiple food items in cold and dry storage were found open and/or uncovered/protected from potential contamination. f. Staff washing dishes was observed on multiple occasions to not wash hands as required after handling dirty dishes and then handled clean/sanitized dishes potentially contaminating them. g. Multiple staff preparing and/or serving food and handling clean dishes were observed to not have hair and/or facial hair effectively restrained. h. Dishwashing racks were observed stored on the floor. i. Facility did not have the correct test strips for the surface sanitizer used at the facility. The facility did not have a current system in place for adequate testing of sanitizer concentrations. 2. Memory Care unit Kitchenette 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: * Door to kitchenette * Wall by the door to the kitchenette * Exterior of insulated cart * Interior of the oven * Exterior of blender b. There was no dedicated sink for handwashing. Multiple staff were observed to wash hands over dishes that were stored in a sink. The other sink had a sanitizer bucket inside the sink. c. A rack of clean dishes was delivered from the main kitchen. Staff observed “clean” fork with a large chunk of food on the tines. Staff indicated that the silverware often comes to them with food particles still on them. d. Multiple items were observed stored in the reach in refrigerator that did not have dates when they were opened or prepared. On 10/02/25 at 1:30 pm, staff 1 (Executive director) and staff 2 reviewed above concerns and they acknowledged areas in need of correction.

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 clean and in good repair in accordance with the 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 and the memory care kitchenette on 12/31/25, from 10:40 am through 12:45 pm, revealed the following deficient practices: 1. Main Kitchen 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; * Top of dish machine; * Interior of ice machine; * Metal movable “speed” racks; * Reach-in cooler in beverage area; * Interior of microwave in beverage/service area; * Juice machine (by spouts) with splash accumulation; * Open stainless steel shelving in front of line storing dishes; * Industrial mixer; * Industrial can opener and housing; * Ceiling vent covers above back food prep area; * Stainless steel shelving where cutting boards were stored; * Walk-in cooler stationary and movable racks; * Flooring under racks in walk-in cooler; * Interior of ovens; * Stainless steel shelving above steam/service line; and * Flooring in janitor closet. b. Multiple food items were observed in the reach-in refrigerator across from the Alto-Sham without dates opened or dates prepared as required. c. One food item in the reach-in refrigerator across from alto-sham found open and/or uncovered/unprotected from potential contamination. d. Staff washing dishes was observed on multiple occasions to not wash hands as required after handling dirty dishes and then handling clean/sanitized dishes, potentially contaminating them. e. Multiple staff preparing and/or serving food and handling clean dishes were observed to not have hair and/or facial hair effectively restrained. f. Dishwashing racks were observed stored on the floor in multiple areas. g. Testing strips indicated surface sanitation solution buckets did not have adequate sanitizer concentrations. h. Surface sanitation solution buckets were observed without towels; towels were observed sitting on prep surfaces and being used without being returned to the sanitation bucket, potentially causing cross contamination. i. Food preparation/handling observed in multiple areas without surface sanitation solution buckets prepared/in use. 2. Memory Care Unit Kitchenette 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: * Dried food spills on the wall behind trash can adjacent to kitchenette door; * Interior of the insulated cart; and * Interior of the oven. b. There was no dedicated sink for handwashing. Sanitizer buckets were observed in both available sinks. c. Sanitizer bucket did not have a towel, and no towel was observed to be in use. d. Testing strips indicated surface sanitation solution buckets did not have adequate sanitizer concentrations. e. Food item observed being stored in the reach-in refrigerator that did not have the date when it was prepared. C455: Based on interview and observation, it was determined the facility failed to ensure their kitchen survey plan of correction was implemented and satisfied the Department. Findings inclu¬¬¬¬de, but are not limited to: Refer to C240. Z142: Based on observation and interview, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. This is a repeat citation. Findings include, but are not limited to: Refer to C240. At approximately 12:45 pm, Surveyor reviewed findings with Staff 1 (Executive Director) and Staff 2 (Executive Chef) and items still out of compliance were acknowledged.

1.Dining Team will clean the Main Kitchen: following areas cited on re servey visit. Top of dish machine, under dishpit walls, floors, drains. Inside ice machine, Drinks station reach in cooler, juice machine spounts, under juice tray, front of line metal shelving with dishes, industrial mixer, can opener and housing, walk in cooler racks, ceiling vents above prep area, stainless ssteel shelving where cutting boards are stored, flooring under racks in walk in cooler, janitor closet flooring, interior oven. Not washing hands properly, storing items on floor, testing strips not in adequate concentrations, santitzing buckets with no rags. 1. MC Kitchette Additional to above: Food spill behind garbage on wall, no hand washing sink 2.Executive Chef has updated cleaning list to reflect items cited in initial and resurvey and assigned to specific personnel. A new microwave was ordered on 1/5/26. Sanitation solution concentrations has been retested and is with in proper limits. Inservice Completed on 1/13/26 to all servers, dishwashers, and cooks on proper hand washing between dirty task vs clean tasks, proper dated and covering of for all food, hair restrainment, and how to store dishwashwashing racks. In service completed on 1/14/26 on proper sanitation handling and use of separate towels for cross contamination. This will be done during EC scheduled days with a walk through of kitchen to review cleaning list by EC and ED EC will oversee and report to ED weekly.

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, observation and review of records, 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.

Use Plan Above

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 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.

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. This is a repeat citation. Findings include, but are not limited to: Refer to C240.

Main Kitchen and MC Kitchen no in compliance per standards of the state at time of re survey. Update task lists created and assigned to all team members for daily, weekly and monthly excepations. MCD will walk MC kitchen on days she is scheduled. MCD and EC will oversee and report to ED weekly.

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: