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 a clean and sanitary kitchen in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: Observations of the kitchen on 01/06/26 showed the following areas needed cleaning or repair: Main Kitchen a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, grease, white billowy matter, and/or black matter was visible on or underneath the following: * Hood vents above range; * Interior of oven; * Floor drain under prep table; * Stainless steel shelf holding spice containers; * Bottom of standing reach-in freezer; * Stainless steel shelf where cutting boards are stored; * Floor behind oven; and * White coated racks in standing reach-in cooler. b. Items in need of maintenance or repair: * Cutting board observed with scoring and or burned/melted areas; * Mechanical ware washing machine not working; * Rust observed on white coated racks in stand-up reach-in cooler; and * Red multi section scoop plates with scoring and or dull finish/lack of glossy coating. c. Multiple open food containers found without open date. d. Non pasteurized eggs in shell being used for preparing egg dishes that are not fully cooked to 145 degrees Fahrenheit. e. Bagged potatoes in dry storage stored in a wire crate that allows for the direct contact of the food product with the floor. f. Spring scale observed stored directly on the floor of the dry storage area. g. Staff 2 (Cook) was unable to adequately describe the two-stage cooling method for hot foods. h. Staff 2 was not able to state desired sanitizer solution concentration range (200 parts per million to 400 ppm) for effective surface sanitation. i. Probe thermometer observed to be used without first sanitizing. Staff 2 indicated probe thermometer is sanitized after use using sanitizer solution and washed with soap and water at the end of the service day; sanitizer solution is not rinsed off before using again resulting in potential chemical contamination. No alcohol wipes in kitchen. j. Multiple dented/damaged food products were observed in the dry storage area, stored with ready-to-use products. Surveyor was told damaged food containers stay on the shelf with usable product. No clear system to prevent use of damaged, potentially hazardous food product. k. Non enclosed wood and spring style “snap trap” for rodents observed on floor behind standing reach in freezer. l. All care staff were observed to handle/deliver food to residents without wearing aprons/protective barriers over their clothing to minimize the potential for cross contamination. m. Hazardous chemicals observed to be stored directly above the designated area for holding clean dishes creating the potential for chemical contamination of the dishes. n. Food observed being prepared without a surface sanitation solution bucket set up and available for use. 2. Building C Kitchenette a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, grease, white billowy matter, and/or black matter was visible on or underneath the following: * Interior of oven; * Range top of oven; and * Bottom of freezer storage area. b. Items in need of maintenance or repair: * Stained, cracked plastic cup with dulled finish. c. Multiple food items on counter without open date. d. Multiple items in refrigerator without open date. 3. Building A Kitchenette a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, grease, white billowy matter, and/or black matter was visible on or underneath the following: *Microwave interior; *Toaster, interior/exterior; *Bottom of the cabinet under the sink; and *Catch tray/ “drain” of ice/water dispenser on front of refrigerator. b. Items in need of maintenance or repair: *Interior of microwave has a non cleanable surface; *Open food items on counter without open date; and *Multiple items in refrigerator without open date. At approximately 1:18 pm, the surveyor reviewed the deficiencies and repair/replacement areas with Staff 1 (Executive Director), Staff 2 and Staff 3 (Nutritionist). They acknowledged the findings

ID Prefix Tag C0240 OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule Main Kitchen: A. Accumulation of food spills, splatters, etc. 1. On 1/6/2026 hood vent was cleaned by maintenance staff. On and between 1/6/2026 and 1/11/2026, interior of oven, floor drain, stainless steel spice rack, bottom of standing reach in freezer, stainless steel shelf that holds cutting boards, floor behind oven, and white coated racks in reach in cooler were assigned to be thoroughly wiped clean, scrubbed, and sanitized by cooks. Cooks completed all assignments within this timeframe. 2. In between professional hood cleanings, maintenance team will address dusty hood vents by wiping clean 1x/ week. Two times per week, every week there will be a deep clean in which the interior of the oven, floor drain, spice rack, bottom of standing reach in freezer, stainless steel shelf that holds cutting boards, floor behind oven, and white coated racks in standing reach-in cooler will be cleaned and sanitized by cook. Nutritionist will be responsible for ensuring this gets done thoroughly by checking and signing off on the duty the morning after. Nutritionist and Resident Care Coordinator (RCC) will also do random audits at least once a week. 3. Main kitchen deep cleans to be completed by cooks 2x/ week. Nutritionist and RCC to ensure task has been completed the following morning and report to Administrator monthly and as needed. 4. Nutritionist, RCC, Administrator B. Items in need of repair 1. On and between 1/6/2026 and 1/11/2026, items in need of repair, including but not limited to plastic cutting boards and red sectioned plates were disposed of and replaced with new items. Mechanical ware washing machine scheduled to be fixed 2/21/2026. White coated racks in standing reach in cooler ordered 1/13/2026 and were delivered and installed 1/15/2026. 2. All cooking and serving supplies, tools and equipment will be audited monthly to ensure heavily scored or worn items are being disposed of and replaced. Mechanical ware washing machine in use daily, if it goes down again cook is plan is to have cook immediately report this to Administrator. In addition, routine checks in kitchen will also be conducted on machinery in kitchen as well as metal racks in fridge and freezer to ensure these items work properly and are without rust and sanitized. They will be fixed/ replaced as necessary. Cooks will be given education on proper care of equipment and when to report. 3. Audits and routine checks to be conducted 1x/ month by Nutritionist and Resident Care Coordinator (RCC) who will report to Administrator monthly and as needed. 4. Nutritionist, RCC, Administrator. C. Open food containers 1. Food in containers without open date were disposed of on 1/6/2026. Labels/pens provided where it's easily accessible. 2. Education and handouts will be provided to cooks and direct care staff that includes food sanitation and the importance of dating and labeling all open food containers upon opening. Auditing fridge and dry storage to make sure everything opened has an open date will be added to nightly closing list so that every night everything has been dated. Random audits of coolers will take place by Nutritionist and Resident Care Coordinator (RCC) to confirm cooks are meeting these expectations. 3. Nutritionist and RCC to check that all food items are being dated 2x/ week and report to Administrator monthly and as needed. 4. Nutritionist, RCC, Administrator D. Non-pasteurized eggs 1. Pasteurized eggs ordered from Sysco 1/13/2026. Cooks educated on use of pasteurized eggs and limitations of non-pasteurized eggs. 2. From 1/13/2026 on, only pasteurized eggs will be ordered. Sysco rep contacted and asked to never substitute non-pasteurized eggs. Cook who accepts inventory should verify only pasteurized eggs are received and notify Nutritionist if any issues. 3. Pasteurized eggs to be ordered weekly. 4. Nutritionist E. Bagged potatoes floor contact 1. On 1/10/2026, cook rearranged kitchen so that there are no items on the bottom of wire racks. All food stored on shelves at least 6 inches off the floor. Education about keeping food items at least 6 inches off the ground provided. 2. Education provided to cooks about keeping food and food items off of the floor, and at least 6 inches above the floor. Nutritionist will verify this rule is being followed weekly when doing inventory and report to Administrator monthly and as needed. 3. Weekly walkthroughs 4. Nutritionist, Administrator F. Spring scale on floor 1. On 1/6/2026, the scale spring was taken off the floor and returned to its place on the wire rack in dry storage. Furthermore, on 1/10/2026 the cook rearranged the dry storage to give the spring scale a more convenient home. 2. Education will be provided to cooks about cross contamination and cleanliness to assure that items that have the potential to be placed on surfaces that food is placed on never comes into contact with the floor. Upon doing inventory, nutritionist will verify all kitchen utensils are not in contact with the floor. 3. Nutritionist will conduct walkthroughs once per week and report to Administrator monthly and as needed. 4. Nutritionist, Administrator G. Two stage cooling method 1. On 1/6/2026 surveyor provided facility with handouts that described the two stage cooling method. Cooks will be assigned further education about the two-stage cooling method by 2/21/2026. 2. Educational handouts will be kept available and posted in the kitchen. Cooks will be randomly quizzed every 3-4 months and observed about safely cooling foods by Nutritionist and/or Resident Care Coordinator (RCC) and report to Administrator every 3 months. 3. Cooks will be quizzed every 3-4 months to brush up on kitchen knowledge. 4. Nutritionist, RCC, Administrator H. Sanitizer solution 1. Nutritionist will walk both cooks through the importance of filling the sanitizer bucket each morning, changing the solution every 3 hours, and testing the solution with strips. 2. Cooks will be responsible for checking sanitizer solution during the day. Nutritionist and RCC will do regular walkthroughs to audit proper sanitizer solution set up and report to Administrator monthly and as needed. 3. Nutritionist and RCC walkthroughs at least 2x/week. Cooks will be quizzed every 3-4 months to brush up on kitchen knowledge. 4. Nutritionist, RCC, Administrator I. Probe thermometer 1. Nutritionist will discuss with both cooks sanitzing the probe thermometer before and after use, and rinsing thoroughly after sanitation to prevent chemical contamination. Alcohol wipes are made available in the kitchen near thermometer probes. 2. Nutritionist and RCC will regularly observe Cooks use of probe thermometers to ensure proper sanitation and rinsing. Questions about sanitizing probe thermometers will be added to kitchen quizzes. 3. Nutritionist & RCC observations at least 2x/week and report to Administrator monthly and as needed. Cooks will be quizzed every 3-4 months to brush up on kitchen knowledge. 4. Nutritionist, RCC, Administrator J. Dented/ damaged food products 1. Dented and damaged products were disposed off on 1/10/2026. Milk crate placed in dry storage by 2/21/2026 with label for “dented/ damaged food products-Do not use" will be used as temporary storage for these items. Education will be provided to cooks and staff about this process by 2/21/2026. 2. Discuss with staff and cooks upon hire about our process for dealing with dented and damaged food products. Nutritionist and RCC will check inventory for dents/damages and discard or return weekly. 3. Nutritionist and RCC will inventory cans weekly when completing inventory. Report to Administrator monthly and as needed. 4. Nutritionist, RCC, Administrator K. Non-Enclosed Snap Trap 1. Non-closed snap trap removed from kitchen 1/10/2026. 2. Verbal education during all staff meeting will be provided to cooks and staff about what snap traps are allowed to be installed in this environment and which snap traps are not. During kitchen walk through, nutritionist and RCCwill check for traps and other potential hazards. 3. Kitchen education for staff 2x/ year. Nutritionist and RCC will do kitchen walk throughs weekly and report to Administrator monthly. 4. Nutritionist, RCC, Administrator L. Aprons 1. Aprons purchased 1/12/2026. Staff instructed to wear via staff messaging portal, to be discussed at next all staff meeting. Aprons will be kept with serving carts. 2. Staff will be reprimanded if seen serving food without apron. RCC will be responsible for guaranteeing staff is wearing aprons when serving meals, and for ordering aprons. 3. Evaluated daily by RCC and cooks. Report to Nutritionist and Administrator monthly and as needed. 4. Cooks, Nutritionist, RCC, Administrator M. Hazardous Chemicals 1. Hazardous chemicals moved into janitorial closet 1/10/2026. Signs to be placed above kitchen sink listing items that are not to be placed in this area. 2. Nutritionist will inventory weekly when doing inventory and during kitchen audits monthly and will report to Administrator monthly. 3. Audited weekly with inventory, monthly during kitchen audit. 4. Nutritionist, Administrator N. Surface Sanitation Bucket 1. Sanitation bucket immediately set up on day of audit when noticed it was not set up. Both cooks have been educated about the importance of setting up a sanitation bucket. 2. Setting up sanitation bucket added to list of opening duties, which needs to be crossed off and initialed daily. RCC to look for sanitation bucket whenever in the kitchen. 3. Daily, setting up sanitation bucket will need to be crossed off list and initialed, RCC will need to check this is done daily. Report to Administrator monthly and as needed 4. RCC, nutritionist, Administrator 2. Building C Kitchenette A. Accumulation of Food Spills 1. Interior of oven and range stovetop cleaned 1/10/2026 by direct care staff. Bottom of freezer storage cleaned 1/6/2026. 2. Cleaning oven that is not in use and stovetop range added to list of cleaning duties for direct care staff. Clean fridge and freezer also added to duties. 3. Weekly cleaning to take place. Monitored weekly by RCC and report to Administrator monthly and as needed 4. RCC, Administrator B. Items in Need of Maintenance Repair 1. Plastic cups inventoried 1/17/2026 and damaged cups disposed of. 2. Nutritionist to also conduct kitchenette audits 1x/ month with help of RCC. Any damaged/ scratched items will be disposed of during audits. Nutritionist and RCC will report to administrator monthly. 3. Audits 1x/ month. 4. Nutritionist, RCC, Administrator C. Multiple Food Items on Counter w/o Open Date 1. Staff alerted that everything needs an open date on 1/6/2026 via staff messaging portal. Staff also asked to toss anything that has been opened and does not have an open date. Further education to take place during all staff meeting. 2. Kitchenette’s food items in kitchenettes checked 2x/ week by nutritionist and RCC to look for opened and undated foods in fridge and on counters. Staff will be asked to initial when dating food items. Nutritionist and RCC will report to Administrator monthly. 3. Audits 2x/ week. 4. Nutritionist, RCC, Administrator D. Multiple Items in Refrigerator without Open Date 1. Staff alerted that everything needs an open date 1/6/2026 via staff messaging portal. Staff also asked to toss anything that has been opened and does not have an open date. Further education to take place during all staff meeting. 2. Kitchenette’s audited 2x/ week by nutritionist and RCC to look for opened and undated foods in fridge and on counters. Staff will be asked to initial when dating food items. Nutritionist and RCC will report to Administrator monthly. 3. Audits 2x/ week. 4. Nutritionist, RCC, Administrator 3. Building A Kitchenette A. Accumulation of Food Splatters... 1. Microwave interior cleaned 1/06/2026. Toaster cleaned 1/16/2026. Bottom of the cabinet cleaned under the sink 1/06/2026. Catch tray/ “drain” of ice water/ dispenser on front of refrigerator cleaned 1/06/2026. 2. Staff notified to clean and sanitize microwave interior out daily; toaster, catch tray/drain weekly. Added to list of duties for direct care staff. Toaster cleaning added to list of duties for caregivers, to be done weekly. 3. Nutritionist and RCC responsible for random audits at least 2x/week and weekly walk-throughs. report to Administrator monthy 4. Nutritionist, RCC, Administrator B. Items in Need of Maintenance or Repair 1. Microwave replaced 1/18/2026. Staff alerted that everything needs an open date on 1/6/2026 via staff messaging portal. Staff also asked to toss anything that has been opened and does not have an open date. Further education to take place during all staff meeting about microwave safety and the prevention of burns. 2. This will be added to audit by Nutritionist and RCC completes for kitchenette’s weekly to look for damaged items. Report to Administrator monthly and as needed 3. Audits 1x/ week. 4. Nutritionist, RCC, Administrator

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: