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: 1. Observations of the main kitchen were made on 11/24/25 at 11:40 am through 1:20 pm. a. The following areas were in need of cleaning: ? Food particles and splatter on the interior surfaces of the microwave; ? Food spills and debris on the lower shelves of the prep table and service line; ? Black matter and hard water build-up on the water line inside the ice maker; ? Black matter on walls around the warewasher and sink, as well as the escutcheon and faucet of the three-compartment sink; ? Black matter and dust build-up on the warewasher vent and hood interior; ? Dust build-up on the underside of the sink in the warewashing area; ? Rust and corrosion on the warewasher, pipes and valve, thermostat, electrical box; and ? Black matter on the blade and housing of industrial can opener. b. The following areas were in need of repair: ? A square opening had been cut into the kitchen wall to vent a portable AC machine; the wall was not sealed around the hose, exposing the kitchen to the exterior of the building where rodents and insects could potentially gain access; and ? The flange around the food disposal opening on the counter in the warewashing room was uncleanable. c. Multiple food items in dry storage room and on the lower shelf of the prep station were found open and/or uncovered/protected from potential contamination. d. The warewasher was observed during multiple cycles, and did not reach 180 degrees Fahrenheit during sanitization rinse cycle. Staff were aware of this and were using the three-compartment sink with automated sanitizer solution; the dispenser did not pour strong enough sanitizer concentration when measured with test strips. A technician corrected the concentration levels, and staff demonstrated adequate sanitizing levels with test strips. At 2:35 pm on 11/24/25, the Administrator (Staff 1) reported all dishes and cookware would be washed and sanitized in the three-compartment sink until the warewasher was repaired or replaced. All staff would receive training on proper sanitization procedures and use of test strips. 2. Observations of the Tuscan MCC kitchenette were made on 11/24/25 at 1:25 pm. a. The following areas were in need of cleaning: ? Black matter in the seams between the countertop and undermount sink surface on the dishwashing and handwashing sinks; and ? Black matter and stains in the interior of the base cabinet to the right of the dish machine. b. The following areas were in need of repair: ? Cabinet faces were scratched and worn, exposing bare wood along multiple base cabinet doors and frame pieces surrounding entry doors to the kitchenette; ? Two base cabinet doors were loose on their hinges and were unable to close completely; ? The dish machine did not reach 180 degrees Fahrenheit during the sanitization rinse cycle. Staff 1 reported all dishes for the Tuscan House would be washed in their two compartment sink and sanitized in a tub of bleach solution until the dishwasher was repaired or replaced. All staff would receive training on proper sanitization procedures and use of test strips. c. Additional observations: ? Two trays of uncovered glasses of water and juice were observed in the refrigerator; ? Multiple covered plates, bags and containers of food in the refrigerator were unlabeled; ? After washing, silverware was left on the countertop to dry, unprotected from potential contamination; ? Tables in the dining room adjacent to the kitchenette revealed scraped and gouged wooden legs and worn table top edges that exposed bare wood, making them uncleanable. 3. Observations of the Ranch House were made on 11/24/25 at 2:05 pm. a. The following areas were in need of cleaning: ? Food splatter and dust on cabinet fronts on base cabinets near the trash cans and serving station. b. The following areas needed repair: ? Caulk was separated from the dishwashing sink at the counter seam; the remaining caulk was lined with black matter. c. Additional observations: ? Uncovered glasses of water and juice were observed in the refrigerator; ? Multiple covered pans, plates and baggies of food were unlabeled; and ? Silverware was stacked in a utensil holder with food surfaces facing up, unprotected from potential contamination. The above findings were reviewed with Staff 1 and the Dietary Director (Staff 2) on 11/24/25 at 3:10 pm. They acknowledged the areas in need of correction. Aging and People with Disabilities Safety, Oversight and Quality PO Box 14530 Salem, Oregon 97309 Phone: 503-373-0200 Fax: 503-373-0222 Department of Human Services Statement of Deficiencies and Plan of Correction Provider/Supplier/CLIA Identification Number: 50M428 Date Survey Completed: GUARDIAN ANGEL HOMES MEMORY CARE 540 NW 12TH ST HERMISTON, Oregon 97838 Umatilla 50M428 - KIT008044 - Visit of . 50M428 - KIT008044 - Visit of .

Maintenance and dietary staff will collaborate to identify appropriate cleaning agents and approved cleaning techniques to effectively remove black residue observed around countertops, undermount sink areas, the dishwasher, the handwashing station, and surrounding cabinetry. The dietary manager and dietary staff will routinely monitor these areas throughout each day to ensure cleanliness is maintained and to prevent reoccurrence. The dietary manager will notify and work closely with maintenance staff to assess the condition of the kitchen and dining areas requiring repair or refurbishment. Affected areas include cabinet faces and door frames, loose or damaged hardware in the kitchen, and dining room furnishings such as table legs and edges. Dietary and house staff will assist in monitoring these areas and will promptly inform maintenance of any future repair needs. The dishwashing machine is currently not reaching the required 180°F necessary for proper sanitation. The dietary manager will work with maintenance staff to assess and correct this issue and will monitor the equipment for any future reoccurrence. In the interim, the dietary manager will train and support dietary and house staff on proper manual sanitization procedures, including the use of the three-sink method, bleach solutions in tubs, and appropriate use of sanitizer test strips. Refrigerators will be monitored daily by dietary and house staff to ensure all food and beverages are properly covered, labeled, and stored to prevent contamination. The dietary manager will reinforce the importance of food safety, food contamination prevention, and proper labeling practices to ensure staff compliance. The dietary manager will remind and educate staff on proper post-washing handling of silverware to prevent contamination. Corrective instruction will be provided as needed, and compliance will be monitored. At the Ranch House location, observations identified similar concerns around the sink area. The dietary manager will coordinate with maintenance to address needed repairs and to determine appropriate cleaning solutions for removing black residue. Dietary and house staff will continue to monitor these areas, apply proper cleaning techniques, and keep maintenance informed to prevent reoccurrence. The dietary manager will continue to reinforce food safety knowledge, including proper food covering and labeling practices, to prevent contamination. Dietary and house staff will jointly monitor food storage and refrigeration areas to ensure ongoing compliance with established procedures. Lastly, the dietary manager will remind house staff of proper silverware sanitation procedures and will monitor practices in collaboration with house staff to ensure silverware is handled and stored correctly at all times.

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 411-054-0030 (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: 1. Observations of the main kitchen were made on 03/23/26 at 10:50 am through 11:20 am. a. The following areas were in need of cleaning: * Food particles and splatter on the interior surfaces of the microwave; * Black and pink matter and hard water build-up on the water line inside the ice maker; * Black matter on walls around the warewasher and sink, as well as the escutcheon and faucet of the three-compartment sink; * Black matter and dust build-up on the warewasher vent and hood interior; * Dust build-up on the underside of the sink in the warewashing area; * Rust and corrosion on the warewasher, pipes and valve, thermostat, and electrical box; and * Black matter on the blade and housing of industrial can opener. b. The following areas needed repair: * The flange around the food disposal opening on the counter in the warewashing room was uncleanable; and * The lower shelf of the prep table near the serving line was broken and one edge was resting on the floor. c. The warewasher was observed during multiple cycles and did not reach 180 degrees Fahrenheit during the sanitization rinse cycle. At 10:55 am on 03/23/26, Staff 9 (Dietary Director) stated staff use the three-compartment sink to wash, rinse, and sanitize dishes that went through the warewasher for the purpose of cleaning food from the dishware. She stated the facility was out of test strips. At 12:10 pm on 03/23/26, Staff 1 (Administrator) stated she was unaware kitchen staff had not been using test strips in the three-compartment sink or to test cleaning solutions. She confirmed Staff 9 had ordered test strips from Sysco and stated training for staff in proper use of test strips would be conducted once they arrived the next day. 2. Observations of the Tuscan MCC kitchenette were made on 03/23/26 at 11:20 am. a. The following areas were in need of cleaning: * Black matter in the seams between the countertop and undermount sink surface on the dishwashing and handwashing sinks; and * Black matter and stains in the interior of the base cabinet to the right of the dish machine. b. The following areas were in need of repair: * Cabinet faces were scratched and worn, exposing bare wood along multiple base cabinet doors and frame pieces surrounding entry doors to the kitchenette; * Two base cabinet doors were loose on their hinges and were unable to close completely; * The dish machine did not reach 180 degrees Fahrenheit during the sanitization rinse cycle. Staff 9 reported all dishes for the Tuscan House were hand-washed in their two-compartment sink and sanitized in a tub of bleach solution. There were no test strips to ensure disinfectant solutions were at the required concentration for proper infection control. c. Additional observations: * Tables in the dining room adjacent to the kitchenette revealed scraped and gouged wooden legs, making them uncleanable. 3. Observations of the Ranch House kitchenette were made on 03/23/26 at 11:35 am. a. The following areas were in need of cleaning: * Food splatter and dust on cabinet fronts on base cabinets near the trash cans and serving station. b. The following areas needed repair: * Caulk was separated from the dishwashing sink at the counter seam; the remaining caulk was lined with black matter. The above findings were reviewed with Staff 1 and Staff 9 on 03/23/26 at 12:10 pm. They acknowledged the areas in need of correction.

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 333150-000. This is a repeat citation. Findings include, but are not limited to: All cleaning and repairs cited in the SOD were addressed before the end of the business day on the inspection date. A daily and weekly cleaning duty list has been updated with more detail to include more detailed instructions for each area of concern. Also, specifically assigning cleaning tasks to indiviual kitchen staff to ensure accountability. Staff are required to initial their list upon completion and then notify the kitchen manager of the completion verbally or by text. In the memory care homes kitchens the staff on shift during NOC have task lists for cleaning the kitchens. Dietary staff will audit the kitchens for all areas and ensure the tasks are done daily. The dietary staff will keep the RCC informed of any missed tasks and floor staff will be held accountable. The kitchen manager will monitor all kitchen areas in AL and MC for cleanliness throughout the day through observation and formal audits 3 times weekly based on the cleaning checklist and floor staff cleaning task list. The kitchen manager with perform the daily and weekly audits and report to the administrator. The following areas needed repair: * The flange around the food disposal opening on the counter in the warewashing room was uncleanable; and the lower shelf of the prep table near the serving line was broken and one edge was resting on the floor. The maintenance department will replace the flange that is over the food disposal to ensure a better fit and a cleanable surface. The prep table will be repaired by the maintenance department or replaced if repair is not possible. The warewashers will be replaced in the memory care but until then the staff will use the three sink method. Maintenance will clean and recaulk all sinks in food prep areas and hand washing sinks. They will also address the stains in the cabinet by the dish machine. The warewasher was observed during multiple cycles and did not reach 180 degrees Fahrenheit during the sanitization rinse cycle. At 10:55 am on 03/23/26, Staff 9 (Dietary Director) stated staff use the three-compartment sink to wash, rinse, and sanitize dishes that went through the warewasher for the purpose of cleaning food from the dishware. She stated the facility was out of test strips. At 12:10 pm on 03/23/26, Staff 1 (Administrator) stated she was unaware kitchen staff had not been using test strips in the three-compartment sink or to test cleaning solutions. She confirmed Staff 9 had ordered test strips from Sysco, and stated training for staff in proper use of test strips would be conducted once they arrived the next day. Test strips were ordered and received. The warewasher will be replaced but until it arrives the kitchen will use the three sink method to clean and sanitize dishes and utensils. The dietary manager trained the staff on the proper three sink method and training on using the sanitizing test strips as well as the temp strips for testing the warewasher. 2. Observations of the Tuscan MCC kitchenette were made on 03/23/26 at 11:20 am. a. Maintenance will clean and recaulk all sinks in food prep areas and hand washing sinks. They will also address the stain on the cabinet near the warewasher. b. Cabinets- the maintenance department will repair the cabinets that are still strucurally sound and then replace the cabinets that require replacement. The maintenance department will refinish or replace damaged tables. 3. Observations of the Ranch House kitchenette were made on 03/23/26 at 11:35 am. a. All cleaning is on a daily and weekly schedule. Dietary staff to audit all cleaning in the memory care kitchens. c. The warewashers will be replaced asap. In the mean time the staff will use the three sink method. All testing of solution will be monitored by the kitchen manager.

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 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:

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 C240.

see C 240

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:

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

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: