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: Observations of the main facility kitchen and the North and South unit kitchenettes on 08/13/26 from 10:15 am through 1:15 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: * Flooring under three compartment sink; * Industrial mixer; * Industrial can opener; * Exterior of white bulk food storage containers; * Ceiling vents; * Wall in dry storage room by vent; * Blender bases; * Interior of deli fridge; * Exterior and handles of hot holding cart; * Interior and exterior of two-door cooler; * Interior of ice machine; * Walk-in cooler fan covers; * Stainless steel shelving storing clean dishes; * Ice scoop holder; and * Multiple floor drains. b. The following areas needed repair: * Down spouts for draining sinks into the floor drains did not have an air gap for potential backflow; and * Metal rack in walk-in cooler did not allow for the freezer door to open freely/unobstructed. c. Multiple potentially hazardous food items were found without open or prepared dates. d. Multiple food items found past the manufacturers’ use-by dates. Multiple prepared foods were found open past seven days and in need of discarding. e. Staff beverages found stored in reach in cooler and deli cooler where residents’ food was stored. f. Multiple grey plastic bowls, a blue plastic plate and two white cutting boards were heavily scored and/or stained. g. Multiple single service items were stored in the dry storage area with the food contact surfaces uncovered and unprotected from contamination. h. A cook was observed to deliver food items to the unit kitchenettes wearing disposable gloves. He was observed to touch multiple surfaces including his badge, door handles and other contaminated surfaces. He was observed to reenter the kitchen and did not change gloves nor wash his hands and proceeded to handle multiple service items. i. At 12:15 pm, Staff 2 (Culinary Director) was interviewed and could not effectively demonstrate knowledge of main allergens. He also confirmed the facility had not trained staff on food allergens, signs and symptoms of an allergic reaction and what to do if observed. At 1:15 pm on 08/13/26, surveyor reviewed with Staff 1 (Administrator) the above areas and they were acknowledged.

1. Main kitchen industrial mixer, industrial can opener, exterior of white bulk food storage containers, ceiling vents, walls in dry storage, blender bases, interior of deli fridge, exterior and handles of hot holding carts, interior and exterior of two-door cooler, interior of ice machine, walk-in cooler fan covers, stainless steel shelving for clean dishes, ice scoop holder, flooring under three compartment sink, and floor drains have been deep cleaned to remove accumulation of food spills, splatters, loose food, trash debris, dirt, dust, black matter, and grease. 2. Down spouts draining into floor drains in the main kitchen have been repaired to allow proper air gap for potential backflow. Metal racks in the walk-in cooler have been replaced to allow freezer door to open freely without obstruction. All food has been inspected and has open and prepared dates, no food in the kitchen is past its expiration date. All prepared food is within the seven days before discarding. Staff reeducated on personal items not being stored in the deli cooler where resident’s food is stored. A shelf has been labeled and a tray placed in the two-door cooler dedicated for staff personal food items. Staff educated on the dedicated shelf in the two-door cooler being the only location within the kitchen where personal food items can be stored. Grey plastic bowls, blue plastic plates, and two white cutting boards have been replaced. Single serve items in dry storage have been covered and protected from contamination. 3. Culinary Director and Culinary team have been reeducated on using open dates and prepared dates, monitoring and discarding food by expiration dates or by seven days for prepared food. Reeducation completed via policies and procedures and training courses. Culinary team reeducated on proper use of disposable gloves when changing tasks or touching dirty versus clean items. Culinary Director and Culinary team reeducated on the importance of entering maintenance needs into TELs system versus verbal notification. Culinary director completed ServSafe Allergens course. Culinary team educated on Big nine allergens, food allergy reaction identification, and prevention. Culinary team will conduct bi-monthly department meetings to reinforce Food Code and Sanitation rules and requirements. Culinary team will follow a concise sanitization schedule daily, with compliance verified by ED and Culinary Director bi-weekly. Culinary team with spot check kitchen for open/use by dates, expiration dates, and personal items only on the single dedicated shelf at the completion of each meal. ED and Culinary Director will review Culinary processes quarterly.

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.

See C240

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: