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 or served residents with pureed textures palatable meals. Findings include, but are not limited to: Observation of the facility house kitchens (Douglas and Ramp) on 03/13/25, from 10:30 am through 1:30 pm, revealed the following: 1) Ramp House 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: * Under the counter can opener; * Interior of oven; * Underneath range burners on cook top stove; * Interior of drawer under oven; * Interior of multiple drawers and cabinets storing food and/or cooking equipment; * Interior of lid of large chest freezer in garage; and * Interior of ice makers. b. The following areas needed repair: * Damaged caulking behind sink area; * Worn/exposed porous wood sections, yielding unsmooth surfaces, on interior of multiple drawers and cabinets; * Pipes under sink with active leaks and free-standing water in buckets/plastic containers; and * Multiple worn and uneven areas on countertop, leaving surfaces unsmooth and uncleanable. c. Multiple potentially hazardous food items were observed without open dates. d. A pan of raw chicken was observed stored directly on top of a bowl of ready-to-eat (RTE) pudding. Whole shell raw eggs were stored directly next to and touching multiple containers of RTE yogurts. Care staff were informed that the pudding would need to be discarded related to potential contamination. Staff 1 (Administrator/Person In Charge) was informed of the poor storage practices and the need to discard the food product. Staff 1 acknowledged the potential danger and contamination risk. e. Two large chest freezers were stored in the garage section. The freezers were stored directly next to personal care items, a recliner chair, and various other items that posed a potential cross contamination risk to the freezers and food items. Multiple garden/yard chemicals were found also stored in the garage, approximately 10-15 feet away from the freezers, and were not in closed/separate cabinets or containment units. An open half-full container of paint was found 10-15 feet from the freezers. The garage was not clean or kept in a sanitary condition and posed a potential contamination risk to food stored in the area. f. Multiple empty recyclable containers/pop cans and bottles were found stored on the countertop, directly above food prep spaces, rather than stored in a covered and approved container to minimize potential contamination and/or attracting pests. g. Staff drinks were stored in the kitchen area and were not of appropriate style, yielding potential of hand-to-lip contamination. h. Staff were not aware of the proper sanitizing solution parts per million needed for proper sanitizing of surfaces. The solution was checked and was at greater than 600 ppm of quaternary ammonia. Staff were not aware of the needed range for effective sanitation. 2) Douglas House 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: * Reach-in refrigerators and freezers; * Interior of drawers and cupboards; * Interior of oven; * Interior and exterior of microwave; * Interior of ice makers; and * Drawer under oven where pan lids were stored. b. The following areas needed repair: * Worn/exposed porous wood sections on the interior of some drawers and cabinets, yielding unsmooth surfaces; and * The internal mechanism of the sanitizer dispenser for kitchen surfaces was damaged and not operating correctly. c. Multiple food items were observed stored in reach-in refrigerators with no date opened noted. A bag of salad was found without a prepared date noted. d. Packages of raw meats were observed stored directly next to gallons of ready-to-drink milk containers, causing the potential for cross contamination. e. House did not have any strips for testing sanitizer solution concentration to ensure appropriate PPM was utilized. Staff was not aware of the chemical used nor the proper PPM that was needed to sanitize. Surveyor used their strips to test the liquid in the sanitizer bucket and no PPM were detected. Staff indicated they must have forgotten to put in the tab. Staff then indicated that they use a spray from a dispenser from chemical room to sanitize. Surveyor reviewed the product, and it was labeled bathroom cleaner. Staff 2 (Assistant Administrator) was contacted and reported they had recently switched to a vendor that managed their chemicals. Surveyor reviewed the chemicals with Staff 2 who was not aware of the effective chemical for sanitation nor the proper PPM that was needed to sanitize surfaces in the kitchen. Surveyor reviewed provided label information and verified chemical to dispense was quaternary ammonia, and the system should dispense a diluted product at 200 PPM. Surveyor tested the chemical coming out of dispenser and it was not registering any PPM. After investigation, it was found that the mechanism in the dispenser was not holding the chemical in the tube so the sanitizer was not mixing correctly. Eventually the chemical did dispense correctly, after 30 seconds of continuous run, allowing time for the chemical to get from the bottle up to the dispenser. Staff were unaware of this malfunction. Multiple bottles of “dispensed” sanitizer were checked and did not have any PPM registering. Staff remade the bottles to ensure product was at the correct PPM for future sanitation. Staff 1 (Administrator) and Staff 2 verified the facility did not have a system to check to ensure product was dispensing correctly and was trusting the vendor and the dispenser. Staff 2 contacted the vendor, who indicated they would be out in a few days to fix the dispenser. Care staff were not aware of the needed contact time for the dispensed chemical to be effective nor the need to let it air dry. Staff interviewed indicated they were wiping off the sprayed chemical after spraying, which was not in line with directions for proper use. f. Staff was not observed to sanitize the thermometer prior to checking food temperatures. g. The house had one resident requiring puree textured foods. The resident was served one bowl of food for lunch that had all meal items pureed together in one blender and served as one dish. Staff was interviewed and stated this was a common practice, as they only had one blender. Surveyor reiterated the need for separate foods to be pureed separately so that all foods/menu items could be tasted and eaten separately for palatability. Care staff, Staff 1, and Staff 2 all acknowledged they would eat the menu items separately and agreed that residents with puree texture diets should be able to eat their food items the same as other residents were offered meals, despite texture modification. At approximately 1:00 pm, Staff 1 and Staff 2 reviewed all areas needing corrective action, and both acknowledged the findings.

Pacific Living Centers of Roseburg at Ramp will implement the following: 1) *An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter, and grease was visible on or underneath, interior of the oven and drawer of oven as well as underneath range burners on cooktop stove were immediately cleaned. The interior lid of the large chest freezer in the garage has been cleaned. have been cleaned. Interior of ice makers: Ice makers removed and disposed of. Under the counter can opener has been removed and disposed of. * Interior of multiple drawers,cabinets, counter tops storing food and/or cooking equipment, Worn/exposed porous wood sections, yielding unsmooth surfaces, WE NEED to ask for extension please, we are getting quotes on the costs to fix , replace them. Requested extension until 6/1/26 please. * Damaged caulking behind the sink area has been stripped and re-caulked. *Pipes under the sink with active leaks and free-standing water in buckets/plastic containers have been fixed. * Multiple potentially hazardous food items were observed without open dates Multiple food items were observed stored in reach-in refrigerators with no date opened noted. A bag of salad was found without a preparation date noted. These items were immediately disposed of. Staff re-education and accountability for open dates conducted, open date stickers also purchased. *A pan of raw chicken was observed stored directly on top of a bowl of RTE pudding. Whole shell raw eggs were stored directly next to and touching multiple containers of RTE yogurts. Packages of raw meats were observed stored directly next to gallons of Ready-to-drink milk containers, causing the potential for cross contamination. These Items were immediately disposed of. *Two large chest freezers were stored in the garage section. The freezers were stored directly next to personal care items, a recliner chair, and various other items that posed a potential cross contamination risk to the freezers and food items. Multiple garden/yard chemicals were also stored in the garage, approximately 10-15 feet from the freezers, and were not in closed/separate cabinets or containment units. An open half-full container of paint was found 10-15 feet from the freezers. The garage was not clean or kept in a sanitary condition and posed a risk to food stored in the area. Maintenance immediately began to clean the garage and dispose of unnecessary chemicals as well as start re-organizing the garage to separate freezers from other items stored there. *Multiple empty recyclable containers/pop cans and bottles were found stored on the countertop, directly above food prep spaces, rather than stored in a covered and approved container to minimize potential contamination and/or attracting pests. All items were immediately disposed of and the area cleaned. Sign put up to remind all staff to rinse and put in the stored covered area in the laundry room, and no cans allowed, also all retrained staff. * Staff drinks were stored in the kitchen area and were not of appropriate style, yielding potential of hand-to-lip contamination. All non approved drinks were immediately disposed of. *Staff were not aware of the proper sanitizing solution parts per million needed for proper sanitization of surfaces. The solution was checked and was greater than 600 ppm of quaternary ammonia. Staff were not aware of the needed Range for effective sanitization. Staff education conducted. Logs and flyers made and posted next to sanitization chemicals for proper PPM solution. *House did not have any strips for testing sanitizer solution concentration to ensure appropriate PPM was utilized. Staff was not aware of the chemical used nor the proper PPM that was needed to sanitize, strips have been purchased and management will be filling and testing bottles weekly. *Staff was not observed to sanitize the thermometer prior to checking food temperatures. Staff were educated on this immediately, reminder signs were also posted for staff reference/reminders. Alcohol swabs are placed in the kitchen to ensure proper sanitization is being done. *The house had one resident requiring puree textured foods. The resident was served one bowl of food for lunch that had all meal items pureed together in one blender and served as one dish. Staff was interviewed and stated this was a common practice, as they only had one blender. Surveyor reiterated the need for separate foods to be pureed separately so that all foods/menu items could be tasted and eaten separately for palatability. Care staff, Staff 1, and Staff 2 all acknowledged they would eat the menu items separately and agreed that residents with puree texture diets should be able to eat their food items the same as other residents were offered meals, despite texture Modification. Staff were immediately made aware of the need to give this resident his food separately.. Careplan updated with this specific too. Staff were educated on the need for separate food groups. A magic Bullet was purchased to ensure the ability to puree all sides and main course separately. 2) Staff have all been retrained on cleaning and a task sheet made for daily sign off on all kitchen tasks completed. Staff education and accountability for cleaning schedules. Kitchen deep cleaning will be daily on the NOC shift. Proper food storage leaflet has been posted for staff retraining/reference to proper food storage. 3) Kitchen tasks/sign off sheet will be completed daily after each shift to verify, wiping/cleaning of surfaces, cleaning of stove top, refrigerators, storing food properly, will be done daily by staff and verified weekly. 4) Executive Director and Assistant Executive Director will be responsible for ensuring the corrections are completed and monitored weekly to verify all kitchen tasks have been signed off on and completed by the staff throughout the week. Alcohol swabs are placed in the kitchen within the area of thermometers, to ensure proper sanitization is being done. Executive Director and assistant Executive Director will be responsible for ensuring that sanitizing strips and testing of bottles will be done weekly. The sanitizer dispenser will be checked by the vendor, every time they come into the building/weekly to verify proper function.

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 411-057-0140(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.

PLEASE REFER TO 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: