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. Findings include, but are not limited to: Observations of the facility kitchen on 03/12/26, from 11:15 am through 12:50 pm, revealed the following deficient practices: 1. 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: * Interior recesses of ice machine; and * Floor drain adjacent to ice machine. b. Items to be repaired or replaced: * Multiple small wares with burn damage/uneven/rusted surfaces, rendering them unable to be cleaned and sanitized. 2. Procedures and Practices: a. Reach-in deli cooler used for holding bread had no interior thermometer. b. Food being handled/prepared without facial hair restraint in use. c. Multiple packaged food items in standing reach-in cooler without an open date. d. Multiple prepared food items in standing reach-in cooler without a label or prepared on date. e. Packaged food item (pepperoni slices) transferred into a container with two separate transferred on dates. f. Multiple packaged food items in standing reach-in cooler transferred from original packaging without an identifying label or date. g. Food preparation was occurring without a surface sanitation solution bucket set up. Surveyor addressed this with Staff 3 (Cook), who continued to prepare/handle food without setting up a surface sanitation solution bucket. Later Staff 3 set up a surface sanitation solution bucket using the wall mounted sanitizer solution dispenser. This surveyor then alerted Staff 3 that the container of sanitizer solution supplying the dispenser was empty, and therefore the surface sanitation solution bucket did not contain a solution with an effective ratio of sanitizer for proper surface sanitizing. Staff 3 did not replace the sanitizer supply container and continued to handle/prepare food. h. Staff 2 (Kitchen Manager) was alerted that the surface sanitation solution bucket was set up from an empty container of sanitizer. Staff 2 then set up a surface sanitation solution bucket with bleach. There were no testing strips available to test the parts per million (PPM) concentration of the surface sanitation solution being used and, therefore, it could not be validated that the solution being used was effectively sanitizing kitchen surfaces. This surveyor then used a chlorine test strip to measure the ppm of the sanitizing solution and found it to be in excess of the desired effective range. i. Staff 2 was unable to state the desired ppm range for chlorine-based surface sanitizing solution. j. Facility staff food was being stored in a reach-in deli cooler intended for resident food items. k. Kitchen staff were preparing “eggs to order” (over easy, sunny side up, etc.) without pasteurized eggs, resulting in undercooked eggs being served to residents. This surveyor instructed kitchen staff this practice could not continue until pasteurized eggs in shell were available for use. l. A digital probe thermometer was inserted into cooked food items without first sanitizing the probe. Staff 2 was observed to use ungloved hands/fingers to wipe off probe thermometer before use. The thermometer was then put away without sanitizing. m. Raw ground protein was being stored directly above ready-to-eat/serve foods intended for residents. n. Lack of handwashing between tasks/changing gloves observed throughout survey. o. Improper food thawing practices were observed. Staff had submerged frozen food in a water-filled container that was sitting next to a sink but without a constant stream of cool water. p. Multiple damaged canned goods in dry storage intermingled with ready-to-use canned food items. q. Staff 3 was unable to state the desired minimum cook to temperature for ground beef. r. Improper cooler hierarchy observed; raw vegetables were stored on the bottom shelf of the standing reach-in cooler right next to raw ground beef. s. During room service delivery, multiple cups filled with ready-to-consume liquids were transported uncovered/unprotected, creating the possibility for contamination. At approximately 1:00 pm, the need for heightened oversight/training on proper food handling procedures was reviewed with Staff 1 (Executive Director) and Staff 2 (Kitchen Manager). The findings were acknowledged by Staff 1 and Staff 2.

1 An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter, and grease was visible on or underneath the following: * Interior recesses of ice machine; and * Floor drain adjacent to ice machine. b. Items to be repaired or replaced: * Multiple small wares with burn damage/uneven/rusted surfaces, rendering them unable to be cleaned and sanitized. A. Immediate Action: The interior recesses of ice machine and floor drain adjacent to ice machine was cleaned on 03/13/2026 to remove all splatters, loose food, trash debris, dirt, dust, black matter, grease and any possible dirt that could contaminate the kitchen B Item all items were replaced 2. Procedure and Practices A. Reach in deli cooler used for holding bread had no interior thermometer but have a thermometer that came with the deli cooler. Immediate action: A thermometer has been purchsed and will be put into the interior of the deli cooler. Staff to record daily temperature of all fridge and freezer to promote food being store at appropriate temperature. B. Food being handled/prepared without facial hair restraint in use Immediate Action: Staff were provided with education on the important of following safety food preparation protocol by wearing facial hair restraint while preparing food to prevent hair from contaminating food. In addition, all staff cooking meals must wear hair nets that's designed to securely cover the hair while preparing food. C. Multiple packaged food items in standing reach-in cooler without an open date. Immediate Action: An audit was done to identify any food items opened without date. All opened food items in the cooler without date was discarded D. Multiple prepared food items in standing reach-in cooler without a label or prepared on date. Immediate Action: An audit was done to identify any prepared food items in the cooler without a label or prepared date. All food items without a label or prepared date was discarded. E. Packaged food item (pepperoni slices) transferred into a container with two separate transferred on dates. Immediate Action: Pepperoni slices were discarded and staff were provided education on the important of labeling food correctly to prevent preparation of contaminated food items. F. Multiple packaged food items in standing reach-in cooler transferred from original packaging without an identifying label or date. Immediate Action: An audit was conducted to identify any food items that has been transferred from original packaging without identifying label or date then discarded them. All staff were provided education on proper food labeling and ensuring open or transfer date are present at all time. G. Food preparation was occurring without a surface sanitation solution bucket setup. Surveyor addressed this with Staff 3 (Cook), who continued to prepare/handle food without setting up a surface sanitation solution bucket. Later Staff 3 set up a surface sanitation solution bucket using the wall mounted sanitizer solution dispenser. This surveyor then alerted Staff 3 that the container of sanitizer solution supplying the dispenser was empty and, therefore, the surface sanitation solution bucket did not contain a solution with an effective ratio of sanitizer for proper surface sanitizing. Staff 3 did not replace the sanitizer Immediate Action: A new sanitizer solution was purchased from our vendo Ecolab right away to ensure proper food handling. Staff was provided with education on the important of having sanitizer solution at all times and to follow manufactural parts per million (PPM) recommendations. I. Staff 2 was unable to state the desired ppm range for chlorine-based surface sanitizing solution. Immediate Action: Staff was provided education on the proper ways of testing parts per million PPM concentration for surface sanitation. Staff was also instructed that the correct concentration for a chlorine sanitizing solution for food that is consider safe and effective is 50-100ppm. j. Facility staff food was being stored in a reach-in deli cooler intended for resident food items. Immediate Action: Staff food were removed from the fridge right away to enforce facility policy and procedure. All staff were educated on the important of following facility personal food storage policy and could only store their food in staff provided fridge in the breakroom k. Kitchen staff were preparing “eggs to order” (over easy, sunny side up, etc.) without pasteurized eggs, resulting in undercooked eggs being served to residents. This surveyor instructed kitchen staff this practice could not continue until pasteurized eggs in shell were available for use. Immediate Action: Pasteurized eggs was purchased by kitchen manager. Kitchen staff was educated to take an inventory of the kitchen atleast once weekly then report to kitchen manager if facility is running low on any produce. Kitchen manager to purchase all needed produce and kitchen supplies. l. A digital probe thermometer was inserted into cooked food items without first sanitizing the probe. Staff 2 was observed to use ungloved hands/fingers to wipe off probe thermometer before use. The thermometer was then put away without sanitizing. Immediate Action: Staff was educated on the important of sanitizing thermometer before and after use to prevent any form of food contamination. Staff was also educated on proper hand hygiene. m. Raw ground protein was being stored directly above ready-to-eat/serve foods intended for residents. Immediate Action: Kitchen staff was educated on proper food storage protocol. Staff will not store raw produce with cooked foods. n. Lack of handwashing between tasks/changing gloves observed throughout survey. Immediate Action: Kitchen staff was provided education on proper hand hygiene and food handling. O. Improper food thawing practices were observed. Staff had submerged frozen food in a water-filled container that was sitting next to a sink but without a constant stream of cool water. Immediate Action: Staff were educated on proper thawing food practices by running constant stream of cool water on frozen food, verbalized understanding with return demonstration. P. Multiple damaged canned goods in dry storage intermingled with ready-to-use canned food items. Immediate Action: Audit were done to identify any damaged produce that was just delivered on 3/11/2026. All damaged produce was accounted for and discarded per facility processes. Staff was also educated to return any damage produce from facility supply during or after delivery. q. Staff 3 was unable to state the desired minimum cook to temperature for ground beef. Immediate Action: Kitchen staff were provided education on desire food temperatures, staff verbalized understanding. R. Improper cooler hierarchy observed; raw vegetables were stored on the bottom shelf of the standing reach-in cooler right next to raw ground beef. Immediate Action: Staff were educated on proper food storage process and not to store raw vegetables with raw ground beef in the same space in the fridge, staff verbalized understanding S. During room service delivery, multiple cups filled with ready-to-consume liquids were transported uncovered/unprotected, creating the possibility for contamination. Immediate Action: Staff were educated on proper delivery system to prevent possible contamination of food produce ready to consume. Staff to cover all food leaving the kitchen to prevent contamination, verbalized understanding. The system will be corrected so that violation not happen again by weekly meeting with kitchen manager to discuss any potential deficiency found in the kitchen department. Daily kitchen and food services observation audit includes storage processes, sanitation needs, staff obligation to wear hair nets, hands washing requirements, kitchen environmental/appliance cleaness needs etc. has been implemented to prevent further deficiency and will be reviewed with kitchen manager weekly. Fridge, and freezer temperature log created to ensure safe food produce storage are implemented. Facility administrator will review log weekly with kitchen manager to enforce compliance and proper documentation. Food temperature log enforced for breakfast, lunch, and dinner to prevent food contamination. The temperature log entails minimum internal food temperatures which will guide staff during food preparation. The administrator/licensee will be responsible to see that the plan of corrections are implemented and monitored

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: