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 the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: Observation of the kitchen and food storage areas on 04/23/26, from 11:00 am through 2:15 pm, revealed the following: 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: * Ceiling above food prep areas; * Ceiling vents above food prep areas; * Walls behind food prep areas; * Wall above steam line service area; * Floor drain under/near ice machine; and * Interior of reach-in refrigerators and freezers. b. The following areas were found in need of repair: * Ceiling vent in dry storage found with large gaps surrounding it where pests/insects could gain entry; * Large section of tiles was observed missing underneath steam line, yielding a non-smooth, non-cleanable surface; * Large area of the wall where the countertop was removed above the steam line/meal service area and needed to be sealed/painted; * Ice machine drainage hose was found stored inside floor drain, touching the bottom of the drain and not providing the necessary air gap to prevent potential back flow; and * Caulking around three-compartment sink was found worn, chipped, or missing and needing repaired. c. Facility did not have chemical test strips to validate effective surface sanitation levels. Surveyor used their own strips and found the sanitation bucket at well over the recommended/needed concentration. Cook on duty was not aware of the sanitation concentration range needed for effective sanitation. Staff 2 (Dining Services Director) acknowledged the facility did not have any strips to validate effective concentrations of the chemical. Staff 2 verified the facility was not checking the concentration of the bucket upon manually mixing the chemical and agreed the concentration was too high. d. Multiple potentially hazardous food items observed stored in reach-in coolers without open dates and/or use-by dates if/when necessary. e. Multiple potential hazardous food items were found stored in reach-in coolers that were past seven days and should have been discarded f. Staff food and/or beverages were observed stored with resident foods/beverages, creating a potential for cross contamination. g. Cook on duty was observed preparing chicken for lunch meal and could not demonstrate appropriate knowledge of the correct cook-to temperature for chicken, stating fully cooked chicken was at 160 degrees not the 165 necessary to be considered safe. h. The facility did not have a small diameter thermometer for temping thin foods. The cook was observed to not sanitize the thermometer before or after checking the temperature of food products. i. The cook serving lunch was observed to potentially contaminate her gloves during service and then handle ready-to-eat food items with the contaminated gloves. j. Care staff were observed to deliver beverages on room trays uncovered and not protected from potential contamination. Surveyor toured kitchen areas with Staff 2, and he acknowledged the identified areas. At 2:00 pm surveyor reviewed above items with Staff 1 (Administrator), and she acknowledged the areas needing correction.

a. Staff cleaned the interior of the refrigerator, freezer and floor drain. 4/24/26 The wall behind the food prep area and above the steam line table were also cleaned 4/24/26. Maintenance will clean the ceiling above the food prep area and the vents above the food prep area. by 5/20/26. Cleaning will take place during non-serving or food prep hours. A cleaning checklist has been put into place with daily, weekly and monthly tasks. 5/7/26 These will be kept in a binder and reviewed by the DSD monthly and ED during audits. Maintenance and kitchen will conduct monthly audits for 3 months, then on-going audits every 90 days to ensrue that the kitchen remains in complaince The ED will join them on the audits. First audit 5/14/26 The DSD, MD, and ED will be responsible for ensuring compliance. b. The ceiling vent will be replaced with the proper sized vent by 5/20/26. The tile work will be scheduled to be completed, pending contractor availability. The wall behind the steam line will be painted and sealed by 6/22/26 The drainage hose was removed after the refrigeration company verified that it was not leading to anything and the unit did not need it. Caulking around 3-compartment sink will be replaced by maintenance by 5/25/26 and during audits will be checked to see that it is in good repair. We have added a maintenance repair log book in the kitchen. C.Test strips were purchased and are now in use as of 4/25/26 and the testing of the sanitation bucket was added to the cleaning tasklist. The sanitation bucket will be changed and checked 3x's per shift and staff will sign off on the cleaning task list 5/7/26. d.The hazardous food items have been removed and all items will be dated in accordance with the rules, staff will be inserviced on this during kitchen inservice 5/14/26. e. Food was discarded 4/23/26 and staff will be inserviced on 5/14/26 during kitchen inservice, this was reviewed after the survey, and again on 5/7/26 F.An outlet was put into the laundry for a staff refrigerator on 5/7/26 for all staff food items to be stored in that unit only. Kitchen staff are attending an inservice on survey findings, cleaning, proper storage of food items in fridges, freezers, temps, cleaning thermometers, a small diameter thermometer was ordered, and cook will be instructed on proper sanitation, they will also inservice on tongs being used to serve bread and other items, paper dollies are being ordered to cover the cups on food trays, saran wrap will be utilized until these arrive to keep drinks covered. 4/24/26 & 5/7/26 Reviewed survey and proper storage, kitchen inservice will be 5/14/26 after 1st audit. All staff 5/19/26 at 3pm Cooking temps are, and have been continuously, posted in the kitchen and this was revewed with the cook that day, again on 5/8/26 and will be done again on 5/14/26 in the kitchen inservice. This will also be an ongoing review during kitchen meetings, inservices, staff will sign off on these reviews and trainings. DSD will ensure this is done, this will be checked during audits. Training will be kept in the all staff training binder in the ED office. h. Small diameter thermometer has been order, the kitchen has thermometers and is temping foods, staff did sanitize the thermometer with an alcohol wipe but was inserviced on the correct procedure for sanitizing thermometers on 4/24/26. Will be inserviced again on 5/14/26. I. kitchen staff was instructed on 4/23/26 about using tongs to avoid potential cross contamination when serving ready to eat foods. Will be inserviced again on 5/14/26 j. Care staff have been instructed to cover drinks when taking room trays, kitchen staff have been instructed to cover drinks as well, we will use saran wrap until dollies arrive. Will inservice again on 5/14/26 and 5/19/26

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 observation and interview, 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.

The administrator will ensure complaince by ensuring the DSD inservices staff on the kitchen regulations and expectations, provide necessary tasklist to ensure that the DSD can hold staff to the expectations of the kitchen cleaning, conducts audits of maintenance and kitchen items to ensure that they are being done following the rules and regulations. These audits will be conducted monthly for 3 months, then every 90 days, kitchen tasklists have been made for daily, weekly and monthly cleaning, inservices have been held and future ones are scheduled to ensure staff are trained on expectations moving forward, a maintenace log book has been placed in the kitchen to request needed repairs and to ensure maintenance follows through, repair work needing to be completed now has been given deadlines for completion, with a backup plan in place and ED will follow up to ensure it is completed on time. A staff fridge has been installed to ensure that staff food items are not held in the fridges for kitchen or resident food items.

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: