The findings of the initial licensure survey, conducted 4/12/22 through 4/13/22, are documented in this report. The survey was conducted to determine compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities, and OARs 411 Division 004 Home and Community Based Services Regulations.

Tag numbers beginning with the letter C refer to the Residential Care and Assisted Living rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

CG:caregiver

cm:centimeter

ED:Executive Director

F:Fahrenheit

HH:Home Health

LPN:Licensed Practical Nurse

MA:          Medication Aide

MAR:Medication Administration

Record

MCC:Memory Care Community

mg:milligram

ml:milliliter

MT:Medication Technician

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

QI:     quality improvement

RCC:       Resident Care Coordinator

RN:     Registered Nurse

TAR:     Treatment Administration

Record

tid:           three times a day

The findings of the revisit to the re-licensure survey of 04/13/22, conducted on 07/14/22, are documented in this report It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities and Home and Community Based Services Regulations OARs 411 Division 004.

Based on observation, interview, and record review, it was determined the facility failed to ensure food was prepared in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to:

Observations of the kitchen and food storage areas revealed:

* Food items in the reach in refrigerators were not covered, labeled, and dated;

* Cups and scoops were left in bins of food;

* Food and refrigerator temperatures were not monitored;

* The dish sanitizer was not monitored to ensure the chlorine sanitizer was dispensing at the correct parts per million.

* Walls throughout the kitchen had splatters, spills, drips, holes, and chipped paint;

* An accumulation of debris was under the shelves in the dry food storage;

* Spills and food debris were on both sides of the range;

* Spills and splatters were on the interior of the oven;

* Storage shelves, cabinets, and drawers throughout the kitchen had debris, splatters, spills, and drips;

* Spills and food debris were on shelves and the bottoms of the refrigerators and freezers;

* The first reach in refrigerator was leaking in the interior; and

* Corner guards by the range and the hand washing sink were in disrepair and coming loose from the wall.

The areas in need of cleaning and repair were reviewed with Staff 1 (Administrator) and Staff 4 (Cook). They acknowledged the findings.

1) The Dietary Manager has been counseled on ensuring the kitchen is kept clean and in good repair.

*Kitchen will be cleaned and

areas needing repair will be fixed

2) Dietary staff to be re-trained on the expectations of kitchen cleanliness.Cleaning scheduled to be implemented and monitored.

3) Daily monitoring by kitchen staff. Weekly and random monitoring/audits by management

4) Administrator, Dietary Manager and/or designee

Based on observation, interview, and record review, 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 C 240.

Refer to C 240

1) The Dietary Manager has been counseled on ensuring the kitchen is kept clean and in good repair.

2) Dietary staff to be re-trained on the expectations of kitchen cleanliness.

3) Daily monitoring by kitchen staff. Weekly and random monitoring/audits by management

4) Administrator, Dietary manager  and/or designee