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 between 11:00 am and 12:45 pm on 05/19/26 showed the following deficiencies: 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: * Housing of commercial can opener-build up of black matter; * Center island-ends of island (spills/drips/splatters); * Baseboard at bottom of center prep island; * Bottom shelf of freezer in downstairs dry storage area; * Interior of freezer door in downstairs dry storage area; * Box fan in kitchen; and * Significant buildup of ice on bottom shelf of middle freezer in kitchen. b. Items in need of maintenance or repair: * Interior of microwave in kitchen with scorched areas rendering it unable to be cleaned and sanitized; * Significant ice buildup around lid of chest freezer in downstairs dry storage area rendering it unable to be completely closed; * Ice build-up on lower shelf of freezer in kitchen; and * Freezer in downstairs dry storage area not keeping all food frozen; c. Staff 2 (Cook/Person in Charge-PIC) unable to articulate two stage cooling method. d. PIC unable to articulate effective parts per million (PPM) range for chlorine based surface sanitation solution buckets. e. PIC unable to identify which PPM test strips are to be used for testing the sanitation solution strength in the commercial ware washing machine. f. Improper hierarchy of food items being stored in downstairs dry storage area freezer potentially causing cross contamination. At approximately 12:55 pm, the surveyor reviewed the findings with Staff 1 (Administrator) and Staff 2 (Cook). The staff acknowledged the findings.

• Kitchen was deep cleaned and sanitized on 5/20/2026. Cleaning included the center prep island, baseboards, freezer shelving, freezer doors, and surrounding food preparation/storage areas. • Commercial can opener was disassembled, cleaned, and sanitized on 5/20/2026. • Personal fan was removed from the kitchen on 5/19/2026. • Cook 1&2 was retrained on 5/20/2026 regarding the two-stage cooling process, sanitation procedures, food storage hierarchy, food labeling and dating requirements, and sanitizer testing procedures. Additional return demonstration and re-education were completed following the survey. • Cook 1 & 2 was retrained on chlorine sanitizer PPM requirements, proper use of sanitizer test strips for sanitation buckets and warewashing machine, and sanitation monitoring procedures on 5/20/2026. • Daily sanitation log was implemented on 5/20/2026 for monitoring sanitizer concentrations and kitchen sanitation compliance. • Microwave with scorched interior was replaced on 5/21/2026. • Freezer with ice buildup and temperature concerns was replaced on 5/28/2026. • Wet chemical extinguisher was installed in the kitchen on 5/21/2026. Systems implemented for continuous improvement and correction: • Administrator implemented kitchen sanitation audit checklist/log to monitor cleanliness, food labeling, food storage hierarchy, sanitizer testing, freezer temperatures, equipment cleanliness, and sanitation compliance. • Dietary staff were retrained on “Clean as You Go” procedures and proper kitchen sanitation expectations. 05/20/2026 • Daily sanitizer concentration checks and documentation logs were implemented for sanitation buckets and warewashing machine monitoring. • Administrator added monthly kitchen equipment and sanitation inspections to ongoing facility audit process. • Owner: Administrator • Done daily, monthly, and during routine Quality Improvement reviews until 3 consecutive inspections with no issues, then moving to quarterly monitoring.

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: Facility failed to comply with RCF/ALF rules. Refer to Tag C240

• Administrator reviewed licensing rules for the facility and Chapter 411, Division 57 compliance requirements on 5/19/2026. • Facility corrected all deficiencies identified under Tag C240 related to sanitation, equipment maintenance, food storage, infection prevention, and dietary staff training. Systems implemented for continuous improvement and correction: • Kitchen sanitation audit tools, daily monitoring logs, retraining procedures, and equipment inspection processes were implemented to address compliance with Tag C240. • Administrator implemented ongoing monitoring systems to ensure compliance with Residential Care Facility/Assisted Living and Memory Care Community regulations.

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: