OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. This Rule is not met as evidenced by: Based on observation and interview, it was determined the licensee failed to ensure adequate administrative oversight of facility operations for food services. Findings include, but are not limited to: During the annual kitchen inspection conducted 02/09/26, administrative oversight to ensure adequate food services rendered in the facility was found to be ineffective based on failure to implement plan of correction and ensure adequate oversight to correct deficiencies.

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. 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. Findings include but are not limited to; Failed to ensure adequate administrative oversight of facility operations for food services. Refer to C240

This POC serves for all tags C150, C240, C455 1. PIC will be taking Health Department Approved, ANAB-CFP Accredited Certified Food Manager training course, in addition to this we have an ad on Indeed and are actively interviewing for a new head cook. We will continue providing ongoing training with all kitchen staff. We have purchased 4 new sanitizer buckets that will be placed strategically throughout the kitchen and a timer that is pre-set every hour to cue and remind to check and change sanitzer solution buckets with reminders posted throughout the kitchen reminding staff to return rags to sanitizer buckets after use. I made a laminated food safety reference card with the below infromations and it is posted directly in front of the 3 compartment sink "The two-stage cooling method", "The food temperature danger zone & how long food can safely stay in this temperature", "The effective PPM range for the quat or chlorine surface sanitation solutions". 2. Will be reviewed with kitchen staff during ongoing meal monitoring in addition to this we will meet weekly to discuss ongoing issues with hopes that this will help to retain knowledge 3. weekly and as needed 4. kitchen PIC, Dietary Aides, and adminstration

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. 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 during the annual kitchen survey conducted 02/09/26, 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. Findings include but are not limited to: Observation of the main facility kitchen and the lunch serve out in the dining room on 02/09/26, from 11:30 am through 12:45 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: * Hood vent filters; * Bottom shelf of pull-out freezer drawer in kitchen; and * Steam table water wells. b. Items in need of maintenance or repair: * Color coded cutting board finish worn/scored; * Oven mitts observed with holes/burn marks; * Cooking surface of egg pans stored above range heavily scratched; and * Heavy accumulation of ice on bottom shelf of standing freezer in dry storage area. c. Surface sanitation solution bucket set up without a towel. d. Cook observed serving/preparing food without adequate hair restraint. e. Sanitation towels left on food preparation surfaces/not returned to sanitation solution bucket after each use. f. Cook observed to handle ready to eat food with potentially contaminated gloves, Picture In Charge (PIC) observed this and did not intervene. g. Cook observed to plate food with potentially contaminated gloves/directly touching service area of plate with potentially contaminated gloves. h. Kitchen staff observed to prepare/handle food without a protective barrier for street clothes. i. Cook observed to sanitize probe thermometer with a towel that had been placed in the surface sanitation solution bucket without first rinsing the probe thermometer with clean water to prevent potentially introducing sanitation solution into the food product. Cook stated that rinsing the sanitation solution off of the probe thermometer was not necessary. j. No soap or towels available at hand washing sink. Cook initially gave surveyor a cloth side towel to dry hands with. Cook then gave surveyor paper napkins to dry hands. k. Milk and juice observed in dining room stored in shallow hotel pan with ice only under the food product, not completely up to the level of the product in the container. l. Multiple damaged cans in dry storage stored with usable product. No clear system in place to prevent intermingling of damaged product with useable product. The Person In Charge was unable to articulate the following: m. How foodborne illnesses are transmitted. n. The signs and symptoms of foodborne illness. o. The two-stage cooling method. p. Potentially hazardous foods. q. The food temperature danger zone or how long food product can safely be in this temperature zone. r. What method of sanitation (heat/chemical) is used by the ware washing machine. s. The effective ppm (parts per million) range for quat or chlorine surface sanitation solutions. t. What minimum temperature the ware washing machine must reach for effective chemical sanitation. At approximately 12:45 pm the surveyor met with Staff 1 (Assistant Administrator) and Staff 2 (Head Cook) to review the findings. Staff 1 and Staff 2 acknowledged the findings.

a. 1a. Hood Vent filters & Bottom shelf of pull out freezer drawer have been cleaned and added to swing housekeeping duties 2a. Steam table water wells have been cleaned and implemented cleaning protocols & scheduled cleanings. 2 1a. We have added these duties to the swing housekeeping work flow 2 2a. we have added this to the weekly dietary aide workflow. 3 1a. Daily 3 2a. Weekly 4 1a. Kitchen manager and administration 4 2a. Administration b. 1b. Ordered new Color coded cutting boards, oven mitts, and egg pans (disposed of old worn, heavily used, burnt items). 2b. The accumulated ice on the bottom shelf of the standing freezer in the dry storage area has been cleaned, we are monitoring to make sure theres no further accumlation of ice and need for service repairs or replacement parts. 2 1b. Kitchen manager will order new items as needed. 3 1b. Daily and as needed for equipment 4 1b. Kitchen manager and administration 2 2b. Weekly checks from kitchen manager and admin 3 2b. Weekly 4 2b. Kitchen manager and administratiom c, d, e, h, i 1c,1d,1e, 1h, 1i. We have provided retraining with all kitchen staff with primary focus on the PIC to ensure ongoing training and compliance by all kitchen staff to ensure proper surface sanitation solution and bucket setup is maintained and monitored, to ensure all contamination, food borne illnesses, spread of germs, and provided several posted reminders on the newly created "State Survey food safety and sanitation ready wall" Posters include "how food borne illnesses are transmitted", "Signs and symptoms of food illness", "The two-stage cooling method", Potentially hazardous foods", "The food temperature danger zone & how long food can safely stay in this temperature", "What method of sanitation (heat/checmical) is used by the dish washer", "The effective PPM range for the quat or chlorine surface sanitation solutions" The minimum temperature the ware washing machine must reach for effective chemical sanitation, "3 compartment sink method/order/cleaning/temp". New high temp warewashing machine logs. Includes several food safety protocols from verifiable resources such as foodsafety.gov, FDA, ect. 2. c, d, e, h, i- Will be reviewed with kitchen staff during ongoing meal monitoring 3. c, d, e, h, i -weekly and as needed 4. c, d, e, h, i kitchen manager and adminstration j 1j. We ordered and will have installed a paper towel dispenser at the hand washing sink along with a soap dispenser. k. 1k. Milk and Juice will not be pre-poured anymore resident aides will fill each individual residents cups up with each product at the time they arrive in the dining room for meal service and in between pouring beverages staff will return all beverages to the refridgerator until its used again (no beverages will be left out and or sitting in or on ice an no prepouring beverages ANY LONGER). 2k. Kitchen manager and admin will monitor meal services for staff compliance 3k. All meals until consistency is maintained 4k. Kitchen manager and administration l. 1l. Any products that are damaged and noted during delivery will be immediately returned back to the driver for a replacement, if found after delivery PIC will call delivery driver and request that they provide us with a replacement of the damaged product take photos and provide them to delivery driver for proof and then dispose of and or put them aside for trade upon arrivial of undamaged product/s. Administrator will call and inform all delivery drivers/ vendors that per state and provide them a copy of our state survey for their cooperation. 2l. Administrator has communicated with vendors to inform them of this policy and will continue to assess damage during delivery and inventory 3l. During order delivery 4l. Kitchen manager reports to vendor and or admin to report the damage goods

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 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; a. Items in need of maintenance or repair: * Oven mitts observed with holes/burn marks. b. Surface sanitation solution bucket being used as a presoak container for silverware. c. Food being prepared/handled without a surface sanitation solution bucket set up and in use, potentially creating cross contamination of food preparation surfaces and food items. d. Multiple damaged canned goods intermingled with useable canned goods. The person in charge (PIC) acknowledged these and left them in place. e. The PIC was unable to articulate the following: * The two-stage cooling method; * The food temperature danger zone or how long food product can safely be in this temperature zone; and * The effective ppm (parts per million) range for quat surface sanitation solutions. At approximately 1:40 pm on 04/23/26, the surveyor met with Staff 1 (Assistant Administrator) and Staff 2 (Head Cook) to review the findings. Staff 1 and Staff 2 acknowledged the findings.

This POC serves for all tags C150, C240, C455 1. PIC will be taking Health Department Approved, ANAB-CFP Accredited Certified Food Manager training course, in addition to this we have an ad on Indeed and are actively interviewing for a new head cook. We will continue providing ongoing training with all kitchen staff. We have purchased 4 new sanitizer buckets that will be placed strategically throughout the kitchen and a timer that is pre-set every hour to cue and remind to check and change sanitzer solution buckets with reminders posted throughout the kitchen reminding staff to return rags to sanitizer buckets after use. I made a laminated food safety reference card with the below infromations and it is posted directly in front of the 3 compartment sink "The two-stage cooling method", "The food temperature danger zone & how long food can safely stay in this temperature", "The effective PPM range for the quat or chlorine surface sanitation solutions". 2. Will be reviewed with kitchen staff during ongoing meal monitoring in addition to this we will meet weekly to discuss ongoing issues with hopes that this will help to retain knowledge 3. weekly and as needed 4. kitchen PIC, Dietary Aides, and adminstration

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 the kitchen was clean and in good repair in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include but are not limited to; Facility not in compliance with POC (plan of correction).

This POC serves for all tags C150, C240, C455 1. PIC will be taking Health Department Approved, ANAB-CFP Accredited Certified Food Manager training course, in addition to this we have an ad on Indeed and are actively interviewing for a new head cook. We will continue providing ongoing training with all kitchen staff. We have purchased 4 new sanitizer buckets that will be placed strategically throughout the kitchen and a timer that is pre-set every hour to cue and remind to check and change sanitzer solution buckets with reminders posted throughout the kitchen reminding staff to return rags to sanitizer buckets after use. I made a laminated food safety reference card with the below infromations and it is posted directly in front of the 3 compartment sink "The two-stage cooling method", "The food temperature danger zone & how long food can safely stay in this temperature", "The effective PPM range for the quat or chlorine surface sanitation solutions". 2. Will be reviewed with kitchen staff during ongoing meal monitoring in addition to this we will meet weekly to discuss ongoing issues with hopes that this will help to retain knowledge 3. weekly and as needed 4. kitchen PIC, Dietary Aides, and adminstration

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: