The findings of the kitchen inspection, conducted 7/6/23, are documented in this report. The survey was conducted to determine compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services- Meals, and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

The findings of the first re-visit to the kitchen inspection survey of 07/06/23, conducted 10/16/23, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services - Meals and Oregon Health Service Food Sanitation Rules OARs 333-150-0000

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. Findings include, but are not limited to:

Observation of the facility kitchen was conducted on 07/06/23 from 10:10 am through 2:30 pm and the following was noted:

a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, and/or black matter was visible on or underneath the following:

* Drains throughout kitchen;

* Reach in milk cooler;

* Reach in deli cooler;

* Walk in cooler and freezer floors;

* Plastic racks in freezer;

* Ceiling vents;

* Interior of Ice Machine;

* Interior of microwave;

* Blender base;

* Industrial can opener;

* Large vertical racks stored in Walk in cooler;

* Caulking around the perimeter of dish machine and beverage counter;

* Janitor closet walls, floors; and

* Floors under and in between equipment/corners and edges.

b. The following areas were in need of repair:

* Robocoupe stand cracked, the base was cracked with an approximate two inch piece missing at the base of the bowl;

* Pipe under the dishwasher was leaking;

* Hole behind kitchen door entrance with wiring exposed; and

* Leak under hand washing sink.

c. Tomato slicer, table top mixer were stored uncovered not protected from potential contamination.

d. Multiple kitchen staff preparing and/or serving food did not have hair and/or facial hair effectively restrained as required.

e. Multiple plastic spatulas were found in poor repair being heavily scored, stained with chunks missing. A black utility cart used to deliver room trays to memory care unit was heat damaged leaving deep gouges and scoring.

f. Box containing empty/dirty pop and beer cans were stored in dry storage next to food items.

g. Cooked ready to eat salmon found stored directly under raw beef products;

At approximately 11:30 am to 12:30 pm, the Memory Care Kitchenette was observed and needed cleaning of the drains under the sink and under the steamtable. The reach in refrigerator was found with black mold like substance on the back of the shelf. The microwave, stove top and oven were found with dried on food debris. There was a layer of dust found on the top of the counter directly over the steam table. The floor was dirty underneath the steam table. A box of juice was found stored on the floor. There were three plates of food sitting on top of the counter without means of keeping food hot. When staff checked the temperature before service it was at 122 degrees F or below. Staff were not aware of the correct temperature food needed to be reheated before service to residents. Staff did not sanitize thermometer before or between temping the food. Staff 3 (Memory Care Administrator) acknowledged the areas of concern.

At approximately 2:00 pm, surveyors reviewed above areas with staff 1 (Executive Director) and Staff 2 (Dining services manager) and they acknowledged the identified areas.  

1)Kitchen will be cleaned, in good repair, and in a sanitary manner. Items to be cleaned and or repaired include the following: drains thorough out kitchen, reach in milk cooler, reach in deli cooler, walk in cooler, freezer floors, plastic racks in freezer, ceiling vents, interior of ice machine, interior of microwave, blender base, industrial can opener, large vertical racks stored in walk in cooler, caulking around the perimeter of dish machine and beverage counter, janitor closet walls, floors and in between equipment / corners and edges. Following areas to be repaired: Robocoupe stand, pipe under dishwasher, hole behind kitchen door, leak under hand washing sink, tomato slicer, table top mixer needs protected, multiple kitchen staff needs hair restrained, multiple plastic spatulas needs replaced, box with pop cans to be stored outside, cooked ready to eat food stored properly. Memory Care refrigerator replacement was ordered and scheduled to be installed. Other items scheduled to be cleaned in Memory Care: kitchenette drains, under the sink, under the steam table, dust on steam table, floor under steam table. Box stored on floor was removed. All food will be plated at time of service in Memory Care Kitchenette to assure food temperatures stay within range. Sanitizing stations set up at meal times to assure utensils are properly cleaned in between use.  

2)Cleaning schedules for kitchen staff will be utilized with a sign off sheet to assure compliance. Skills checklist will be completed during orientation and annually. Staff in-service for maintenance request on items that need repair will be completed. Audits will be performed to assure the cleaning schedule and skills check list is completed. Cooks will send all protein down to the steam table and all items will be plated in kitchenette. Temps will be taken at time of plating to assure food is at proper temperature.  

3)Daily cleaning task list, Weekly audits, immediate staff in-service and ongoing monthly in-service and at new hire orientation.

4)The Food Service Manager will be responsible for daily monitoring of cleaning tasks and will report to Executive Director. Executive Director will perform weekly audits to assure compliance. Assistant Executive Director will hold in-service on maintenance request forms for all staff. Assistant Executive Director will review new requests and completion of requests daily. Maintenance Director to fix and order any equipment needed per management request and approval. Memory Care Director will be responsible to assure all skills check list are completed at training and annually. Assistant Executive Director or audit weekly.

Based on observation, record review and interviews it was determined the facility failed to ensure  4 of 25 sampled staff (# 4, 5, 6 and 7) reviewed for food handlers certificates had current cards at the time of survey. Findings include, but are not limited to:

On 7/6/23 the facility was asked to provide verification that staff who prepared food had current food handlers cards. Documentation provided by the facility noted Staff 4, 5, 6 and 7 (kitchen staff) did not have food handlers cards.  Staff 1 acknowledged the missing documentation.

1)All staff who prepare food will obtain a current food handlers card.

2)All staff who will prepare food will obtain a current food handlers card at time of new hire orientation.

3)Weekly Audits to assure compliance.

4)Assistant Executive Director to assure current food handlers card is obtained during new hire orientation. Assistant Executive Director will Audit weekly to assure compliance.   

Based on observation, record review 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.

1)Kitchen will be cleaned, in good repair, and in a sanitary manner. Items to be cleaned and or repaired include the following: drains thorough out kitchen, reach in milk cooler, reach in deli cooler, walk in cooler, freezer floors, plastic racks in freezer, ceiling vents, interior of ice machine, interior of microwave, blender base, industrial can opener, large vertical racks stored in walk in cooler, caulking around the perimeter of dish machine and beverage counter, janitor closet walls, floors and in between equipment / corners and edges. Following areas to be repaired: Robocoupe stand, pipe under dishwasher, hole behind kitchen door, leak under hand washing sink, tomato slicer, table top mixer needs protected, multiple kitchen staff needs hair restrained, multiple plastic spatulas needs replaced, box with pop cans to be stored outside, cooked ready to eat food stored properly. Memory Care refrigerator replacement was ordered and scheduled to be installed. Other items scheduled to be cleaned in Memory Care: kitchenette drains, under the sink, under the steam table, dust on steam table, floor under steam table. Box stored on floor was removed. All food will be plated at time of service in Memory Care Kitchenette to assure food temperatures stay within range. Sanitizing stations set up at meal times to assure utensils are properly cleaned in between use.  

2)Cleaning schedules for kitchen staff will be utilized with a sign off sheet to assure compliance. Skills checklist will be completed during orientation and annually. Staff in-service for maintenance request on items that need repair will be completed. Audits will be performed to assure the cleaning schedule and skills check list is completed. Cooks will send all protein down to the steam table and all items will be plated in kitchenette. Temps will be taken at time of plating to assure food is at proper temperature.  

3)Daily cleaning task list, Weekly audits, immediate staff in-service and ongoing monthly in-service and at new hire orientation.

4)The Food Service Manager will be responsible for daily monitoring of cleaning tasks and will report to Executive Director. Executive Director will perform weekly audits to assure compliance. Assistant Executive Director will hold in-service on maintenance request forms for all staff. Assistant Executive Director will review new requests and completion of requests daily. Maintenance Director to fix and order any equipment needed per management request and approval. Memory Care Director will be responsible to assure all skills check list are completed at training and annually. Assistant Executive Director or audit weekly.