OAR 411-054-0036 (1-4) Service Plan: General (1) If the resident has a Person-Centered Service Plan pursuant to 411- 004-0030, the facility must incorporate all elements identified in the person centered service plan into the resident's service plan. (2) SERVICE PLAN. The service plan must reflect the resident's needs as identified in the evaluation and include resident preferences that support the principles of dignity, privacy, choice, individuality, and independence. (a) The service plan must be completed: (A) Before resident move-in, with updates and changes as appropriate within the first 30-days; and (B) Following quarterly evaluations. (b) The service plan must be readily available to staff and provide clear direction regarding the delivery of services. (c) The service plan must include a written description of who shall provide the services and what, when, how, and how often the services shall be provided. (d) Changes and entries made to the service plan must be dated and initialed. (e) When the resident experiences a significant change of condition the service plan must be reviewed and updated as needed. (f) A copy of the service plan, including each update, must be offered to the resident or to the resident's legal representative. (g) The facility administrator is responsible for ensuring the implementation of services. (h) Changes to the service plan, including updates due to a significant change of condition and quarterly updates must be reflected in the facility’s ABST care elements. (3) SERVICE PLAN REQUIREMENTS BEFORE MOVE-IN. (a) Based on the resident evaluation performed before move-in, an initial service plan must be developed before move-in that reflects the identified needs and preferences of the resident. (b) The initial service plan must be reviewed within 30-days of movein to ensure that any changes made to the plan during the initial 30- days, accurately reflect the resident's needs and preferences. (c) Staff must document and date adjustments or changes as applicable. (4) QUARTERLY SERVICE PLAN REQUIREMENTS. (a) Service plans must be completed quarterly after the resident moves into the facility. (b) The quarterly evaluation is the basis of the resident's quarterly service plan. (c) If the resident's service plan is revised and updated at the quarterly review, changes must be dated and initialed, and prior historical information must be maintained. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to ensure service plans were reflective of residents' current care needs, provided clear direction regarding the delivery of services, and was implemented for 1 of 3 sampled residents (#1) whose service plans were reviewed. Findings include, but are not limited to: Resident 1 moved into the facility in 02/2019 with diagnoses including Alzheimer’s disease, psychotic disturbance, and history of malignant neoplasm of breast. Observations were made of the resident's care from 12/10/24 through 12/12/24. Interviews with staff were conducted and the current service plan, dated 09/03/24, was reviewed. The following was identified: Resident 1's service plan was not reflective of his/her current needs, lacked clear direction, and/or was not implemented in the following areas: * For staff to wait for resident to participate in ADL care and to re-approach as needed; * Frequency of toileting and incontinent care; * Social and physical engagement including staff to take resident on walks throughout the day; * Consistent implementation of severe weight loss interventions; * Consistent implementation of fall risk interventions; * Behavioral interventions; * When to use assistive devices including his/her manual wheelchair; and * Residents ability to self-transfer. The need to ensure service plans were reflective of the residents' current needs, provided clear direction regarding the delivery of services, and was implemented was discussed with Staff 1 (ED), Staff 2 (Memory Care Director), Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings.

1.Resident #1's service plan has been updated to include all required components and to accurately reflect the resident's current status, needs and preferences with clear direction for care staff. A Service plan audit has been completed for all residents to ensure current care needs are reflective and provide clear instructions to care staff. 2. Education conducted with care staff on following interventions outlined in service plans and reporting care discrepancies with residents care needs and the service plan. A 'POC Errors/Issues' form was implemented for care staff to document discrepancies between residents service plan and care needs. Care staff have been trained to submit this form to the administrator to review when completed. 3. Service plans will be reviewed and updated upon admission, at 30 days, quarterly and with significant change of condition. 'POC Errors/Issues' forms will be reviewed, and appropriate service plan updates will be made as needed. 4. The Arbor Administrator and Executive Director will be responsible for maintaining this system.

OAR 411-054-0036 (1-4) Service Plan: General (1) If the resident has a Person-Centered Service Plan pursuant to 411- 004-0030, the facility must incorporate all elements identified in the person centered service plan into the resident's service plan. (2) SERVICE PLAN. The service plan must reflect the resident's needs as identified in the evaluation and include resident preferences that support the principles of dignity, privacy, choice, individuality, and independence. (a) The service plan must be completed: (A) Before resident move-in, with updates and changes as appropriate within the first 30-days; and (B) Following quarterly evaluations. (b) The service plan must be readily available to staff and provide clear direction regarding the delivery of services. (c) The service plan must include a written description of who shall provide the services and what, when, how, and how often the services shall be provided. (d) Changes and entries made to the service plan must be dated and initialed. (e) When the resident experiences a significant change of condition the service plan must be reviewed and updated as needed. (f) A copy of the service plan, including each update, must be offered to the resident or to the resident's legal representative. (g) The facility administrator is responsible for ensuring the implementation of services. (h) Changes to the service plan, including updates due to a significant change of condition and quarterly updates must be reflected in the facility’s ABST care elements. (3) SERVICE PLAN REQUIREMENTS BEFORE MOVE-IN. (a) Based on the resident evaluation performed before move-in, an initial service plan must be developed before move-in that reflects the identified needs and preferences of the resident. (b) The initial service plan must be reviewed within 30-days of movein to ensure that any changes made to the plan during the initial 30- days, accurately reflect the resident's needs and preferences. (c) Staff must document and date adjustments or changes as applicable. (4) QUARTERLY SERVICE PLAN REQUIREMENTS. (a) Service plans must be completed quarterly after the resident moves into the facility. (b) The quarterly evaluation is the basis of the resident's quarterly service plan. (c) If the resident's service plan is revised and updated at the quarterly review, changes must be dated and initialed, and prior historical information must be maintained. This Rule is not met as evidenced by:

OAR 411-054-0040 (1-2) Change of Condition and Monitoring (1) CHANGE OF CONDITION. These rules define a resident's change of condition as either short term or significant with the following meanings: (a) Short term change of condition means a change in the resident's health or functioning that is expected to resolve or be reversed with minimal intervention or is an established, predictable, cyclical pattern associated with a previously diagnosed condition. (b) Significant change of condition means a major deviation from the most recent evaluation that may affect multiple areas of functioning or health that is not expected to be short term and imposes significant risk to the resident.(c) If a resident experiences a significant change of condition that is a major deviation in the resident's health or functional abilities, the facility must evaluate the resident, refer to the facility nurse, document the change, and update the service plan as needed. (d) If a resident experiences a short-term change of condition that is expected to resolve or reverse with minimal intervention, the facility must determine and document what action or intervention is needed for the resident. (A) The determined action or intervention must be communicated to staff on each shift. (B) The documentation of staff instructions or interventions must be resident specific and made part of the resident record with weekly progress noted until the condition resolves. (2) MONITORING. The facility must have written policies to ensure a resident monitoring and reporting system is implemented 24-hours a day. The policies must specify staff responsibilities and identify criteria for notifying the administrator, registered nurse, or healthcare provider. The facility must: (a) Monitor each resident consistent with his or her evaluated needs and service plan; (b) Train staff to identify changes in the resident's physical, emotional and mental functioning and document and report on the resident's changes of condition; (c) Have a reporting protocol with access to a designated staff person, 24-hours a day, seven days a week, who can determine if a change in the resident's condition requires further action; and (d) Provide written communication of a resident's change of condition, and any required interventions, for caregivers on each shift. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to ensure residents who had changes of condition were monitored consistent with his or her evaluated needs through resolution and resident specific interventions were determined and implemented for 1 of 3 sampled residents (#1) who experienced changes of condition including severe weight loss. Findings include, but are not limited to: Resident 1 moved into the facility in 02/2019 with diagnoses including Alzheimer’s disease, psychotic disturbance, and history of malignant neoplasm of breast. The resident was admitted to hospice in 02/2024. The resident's record was reviewed, including the 09/03/24 service plan, Interim Service Plans (ISPs), Nutritional Assessments, significant change of condition documentation, dated 06/20/24 through 11/18/24, Progress Notes, and Incident Reports. Observations were made and interviews were conducted. The following changes of condition were identified: a. On 05/16/24, an RN assessment was completed due to a significant change of condition. The assessment noted the resident’s weight to be 140.3 pounds on 04/19/24 and 114.2 pounds on 05/16/24, which constituted a severe weight loss of 26.1 pounds or 18.6% of his/her total body weight. The assessment identified the following interventions: * Implement fortified meals; * Continue to provide nutritional shakes three times daily; * Staff to physically assist with eating; and * Get resident up and seated in the dining room for all meals. The following weights were documented in the resident record: * 06/15/24 – 122.6 pounds; * 06/21/24 – 119.4 pounds; * 06/28/24 – 117.8 pounds; * 07/05/24 – 116.5 pounds; * 07/12/24 – 116.0 pounds; * 07/19/24 – 113.2 pounds; * 08/02/24 – 113.2 pounds; * 08/10/24 – 112.5 pounds; * 08/23/24 – 110.0 pounds; * 09/06/24 – 108.6 pounds; * 09/27/24 – 107.0 pounds; * 10/04/24 – 105.1 pounds, and a hospice note indicated to discontinue weekly weights on 10/11/24; * 11/04/24 – 99.1 pounds; and * 12/12/2024 – 99.5 pounds. RN assessments, dated 06/27/24 through 11/18/24, identified the following interventions: * Encourage resident to have meals in the front dining room; * May try finger foods for a couple weeks; * Weekly weights; * Avoid sitting resident at dining room table until food is ready and placed at his/her seat; * May leave health shake with resident; * If resident has poor intake, offer finger foods for him/her to carry; * Offer food resident enjoys; * Staff to escort resident to all meals; * Full feeding assist as the resident allows; * Verbal and non-verbal cueing during meals; * Offer additional choices for food options; * Monitor oral intake weekly; and * Offer food/snack in between meals and when s/he wakes up. On 12/11/24, the resident was observed to be offered a nutritional shake and a piece of chocolate, and was noted to consume approximately 75% of his/her lunch with staff prompting, cueing, and assisting with feeding. Resident 1 continued to experience weight loss and the facility identified interventions, however there was no documented evidence the interventions were monitored for effectiveness. On 12/11/24 at 2:55 pm, Staff 2 (Memory Care Director) confirmed there was no documented evidence that nutritional shakes, finger foods, or snacks were provided to Resident 1. There was no documented evidence that fortified meals and finger foods were provided and the interventions including to provide a nutritional shake three times daily, nutritional shakes could be left with the resident, full assistance with feeding, monitoring oral intake weekly, and that food/snacks to be offered between meals or when s/he woke up, were monitored consistent with his/her evaluated weight loss. b. The resident was at risk for falls and ISPs identified the following interventions: * “If staff [do] not see [the resident] in the common area…go check on [him/her] and make sure [s/he] is not in someone else’s room”; and * “Hospice RN is ordering an x-ray.” The resident experienced falls on the following dates: * 10/12/24: Fall in another residents room; * 10/12/24: Unwitnessed fall in common area; * 10/14/24: Unwitnessed fall in dining room; and * 12/01/24: Unwitnessed fall in hallway outside of room 108. There was no documented evidence resident specific interventions were determined or that the resident was monitored consistent with his/her evaluated needs. c. On 10/12/24, the resident’s record identified s/he was hit on the head with a door and there was no documented evidence of resident specific interventions or that the condition was monitored, through resolution. Resident 1 was observed throughout the survey without injury to his/her face or head. The need to ensure residents who experienced changes of condition were monitored consistent with their evaluated needs through resolution and resident specific interventions were determined and implemented was discussed with Staff 1 (ED), Staff 2, Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings.

1. Resident 1 has been assessed by RN to address significant change of condition and service plan have been updated to include clear instructions for staff regarding resident's plan of care. Resident's interventions have been reviewed to ensure they have been appropriately implemented through Care staff charting system (POC) and interventions specific to dietary needs were updated through ISPs and submitted to dietary manager for implementation with kitchen staff. 2. Education provided to Health Services team on ensuring interventions are appropriately implemented through ISPs and/or POC when resident's are evaluated for changes of condition. When residents are being monitored for significant change of condition RN will review interventions weekly for effectiveness and implement changes as needed. All resident's that receive nutrional shakes and snacks have had their Service plan and POC tasks reviewed to ensure they are accurate. 3. Service plans and POC will be reviewed at time of intervention implementation, quarterly and with significant change of condition. Audits of this system will occur as part of monthly CQI process. 4. Memory Care Administrator, Executive Director, Director of Helath Services and RN will be responsible for maintaining this system.

OAR 411-054-0040 (1-2) Change of Condition and Monitoring (1) CHANGE OF CONDITION. These rules define a resident's change of condition as either short term or significant with the following meanings: (a) Short term change of condition means a change in the resident's health or functioning that is expected to resolve or be reversed with minimal intervention or is an established, predictable, cyclical pattern associated with a previously diagnosed condition. (b) Significant change of condition means a major deviation from the most recent evaluation that may affect multiple areas of functioning or health that is not expected to be short term and imposes significant risk to the resident.(c) If a resident experiences a significant change of condition that is a major deviation in the resident's health or functional abilities, the facility must evaluate the resident, refer to the facility nurse, document the change, and update the service plan as needed. (d) If a resident experiences a short-term change of condition that is expected to resolve or reverse with minimal intervention, the facility must determine and document what action or intervention is needed for the resident. (A) The determined action or intervention must be communicated to staff on each shift. (B) The documentation of staff instructions or interventions must be resident specific and made part of the resident record with weekly progress noted until the condition resolves. (2) MONITORING. The facility must have written policies to ensure a resident monitoring and reporting system is implemented 24-hours a day. The policies must specify staff responsibilities and identify criteria for notifying the administrator, registered nurse, or healthcare provider. The facility must: (a) Monitor each resident consistent with his or her evaluated needs and service plan; (b) Train staff to identify changes in the resident's physical, emotional and mental functioning and document and report on the resident's changes of condition; (c) Have a reporting protocol with access to a designated staff person, 24-hours a day, seven days a week, who can determine if a change in the resident's condition requires further action; and (d) Provide written communication of a resident's change of condition, and any required interventions, for caregivers on each shift. This Rule is not met as evidenced by:

OAR 411-054-0050(1-5) Infection Prevention & Control (Amended 03/18/2022)(1) Facilities must establish and maintain infection prevention and control protocols to provide a safe, sanitary and comfortable environment. This includes protocols to prevent the development and transmission of communicable diseases.(2) Each facility must designate an individual to be the facility ' s "Infection Control Specialist" responsible for carrying out the infection prevention and control protocols and serving as the primary point of contact for the Department regarding disease outbreaks. The Infection Control Specialist must:(a) Be qualified by education, training and experience or certification; and(b) Complete specialized training in infection prevention and control protocols within three months of being designated under this paragraph, unless the designee has received the specialized training within the 24-month period prior to the time of the designation. The Department will describe trainings that will be acceptable to meet the specialized training requirement in rule, by January 1, 2022.(3) Each facility must establish infection prevention and control protocols and have an Infection Control Specialist, trained as required in this rule, by July 1, 2022.(4) Facilities must comply with masking requirements as prescribed in OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control the spread of COVID-19.(5) Facilities must comply with vaccination requirements for COVID-19 as prescribed in OAR 333-019-1010.Stat. Auth.: ORS 410.070, 443.004, 443.012, 443.450Stats. Implemented: ORS 443.004, 443.400-443.455, 443.991 This Rule is not met as evidenced by: Based on observation and interview, it was determined the facility failed to establish and maintain effective infection prevention and control protocols to provide a safe and sanitary environment during meal service for multiple unsampled residents and 1 of 2 sampled residents who received ADL care. Findings include, but are not limited to: a. Lunch service was observed on 12/10/24 through 12/12/24. On 12/10/24 during lunch service, staff were observed to assist residents without use of a protective barrier and hand hygiene was not completed in between assisting residents. On 12/11/24 during lunch service, Staff 8 (CG) and Staff 15 (CG) were observed to serve meals, provide meal assistance to multiple residents simultaneously, refill beverages, touch multiple resident’s assistive equipment, and provide escorts for residents who were non-ambulatory, without performing hand hygiene. b. On 12/10/24 at 12:06 pm, while providing toileting assistance for Resident 1, Staff 15 (CG) did not change gloves between touching soiled incontinent supplies and the resident’s clean clothes. Staff 15 did not complete hand hygiene after assisting with toileting and before assisting other residents. The need to ensure universal precautions for infection control were exercised, including appropriate hand hygiene while serving meals and providing care services to the residents, was discussed with Staff 1 (ED), Staff 2 (Memory Care Director), Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings.

1. An in-service training with all current care staff will be performed, with documentation that all staff members have participated and acknowlegde infection control in regards to dining services and providing incontinet care as outlined in OAR 411-054-0050(1-5) 2. To prevent reoccurance of this violation, the dining room will have hand sanitizer and glove dispensers installed. At the time of hire, staff will complete a signed training for infection control through Relias and general orientation. 3. Maintain weekly walkthroughs with observations to ensure that proper infection control practices aer being followed by staff. The weekly walkthroughs will be an ongoing observation with concerns being adressed as needed and reviewed at monthly CQI. 4. Memory Care Administrator and Executive Director will be responsible for maintaining this system.

OAR 411-054-0050(1-5) Infection Prevention & Control (Amended 03/18/2022)(1) Facilities must establish and maintain infection prevention and control protocols to provide a safe, sanitary and comfortable environment. This includes protocols to prevent the development and transmission of communicable diseases.(2) Each facility must designate an individual to be the facility ' s "Infection Control Specialist" responsible for carrying out the infection prevention and control protocols and serving as the primary point of contact for the Department regarding disease outbreaks. The Infection Control Specialist must:(a) Be qualified by education, training and experience or certification; and(b) Complete specialized training in infection prevention and control protocols within three months of being designated under this paragraph, unless the designee has received the specialized training within the 24-month period prior to the time of the designation. The Department will describe trainings that will be acceptable to meet the specialized training requirement in rule, by January 1, 2022.(3) Each facility must establish infection prevention and control protocols and have an Infection Control Specialist, trained as required in this rule, by July 1, 2022.(4) Facilities must comply with masking requirements as prescribed in OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control the spread of COVID-19.(5) Facilities must comply with vaccination requirements for COVID-19 as prescribed in OAR 333-019-1010.Stat. Auth.: ORS 410.070, 443.004, 443.012, 443.450Stats. Implemented: ORS 443.004, 443.400-443.455, 443.991 This Rule is not met as evidenced by:

OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors (d) INTERIOR DOORS. Lever-type door handles must be provided on all doors used by residents.(e) EXIT DOORS. Exit doors may not include locks that delay evacuation except as specified by the building codes. Such locks may not be installed except with written approval of the Department.(A) Exit doors may not include locks that prevent evacuation.(B) If an electronic code must be entered to use an exit door that code must be clearly posted for residents, visitors, and staff use.(f) WALLS AND CEILINGS. Walls and ceilings must be cleanable in kitchen, laundry, and bathing areas. Kitchen walls must be finished smooth per OAR 333-150-0000 (Food Sanitation Rules).(g) ELEVATORS. A RCF with residents on more than one floor must provide at least one elevator that meets Oregon Elevator Specialty Code (OESC) requirements.(h) The interior of the facility must be free from unpleasant odors.(i) All interior and exterior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows, and furniture) and all equipment necessary for the health, safety, and comfort of the resident will be kept clean and in good repair. This Rule is not met as evidenced by: Based on observation and interview, it was determined the facility failed to ensure the environment was maintained in clean and good repair. Findings include, but are not limited to: Observations of the facility on 12/11/24 through 12/12/24 showed the following areas in need of cleaning or repair: * Scrapes and dings were noted on doors or door frames at rooms 101 and 107; * A large gouge/scrape on the wall in living room across from Administrator’s office; * Stains on carpet throughout living room; * Multiple light fixtures throughout the memory care had insects and/or debris in them; and * There was a strong, pervasive urine odor in the hallway outside of Room 105. The areas in need of cleaning and repair were shown to and discussed with Staff 2 (Memory Care Director) and Staff 9 (Plant Operations) on 12/12/24 at 11:30 am. They acknowledged the findings.

1. Interior dings, gouges and scrapes have been repaired and painted and corrected by the maintenance director. The housekeeping manager performed carpet cleaning with a carpet shampooer and excessively soiled carpet squares have been replaced in all areas where stains were presant after cleaning. Arbor Administrator audited all resident apartments to determine sources of odor and then provided training to all care staff regarding the handling of soiled laundry and linens. Additional staff training has been provided for incontinence care including removing incontinence trash from memory care immediately. Charcoal odor eliminators were placed in communal trash and laundry bins. The light fixtures were cleaned and debris removed by the maintenance director. 2. Weekly environemntal walkthrough of memory care with a focus on odors and ensuring community is clean and in good repair. Any areas identified as a concern through the weekly walkthrough will be corrected. 3. Weekly walkthroughs to be evaluated monthly at CQI meetings. 4. Memory Care Administrator, Executive Director and Maintenice Director will be responsible for maintaining this system.

OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors (d) INTERIOR DOORS. Lever-type door handles must be provided on all doors used by residents.(e) EXIT DOORS. Exit doors may not include locks that delay evacuation except as specified by the building codes. Such locks may not be installed except with written approval of the Department.(A) Exit doors may not include locks that prevent evacuation.(B) If an electronic code must be entered to use an exit door that code must be clearly posted for residents, visitors, and staff use.(f) WALLS AND CEILINGS. Walls and ceilings must be cleanable in kitchen, laundry, and bathing areas. Kitchen walls must be finished smooth per OAR 333-150-0000 (Food Sanitation Rules).(g) ELEVATORS. A RCF with residents on more than one floor must provide at least one elevator that meets Oregon Elevator Specialty Code (OESC) requirements.(h) The interior of the facility must be free from unpleasant odors.(i) All interior and exterior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows, and furniture) and all equipment necessary for the health, safety, and comfort of the resident will be kept clean and in good repair. 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, 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 C295 and C513.

Refer to C295 and C513

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:

OAR 411-057-0160(2b) Compliance with Rules Health Care (b) Health care services provided in accordance with the licensing rules of the facility. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to provide health care services in accordance with the licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to: Refer to C260 and C270.

Refer to C260 and C270

OAR 411-057-0160(2b) Compliance with Rules Health Care (b) Health care services provided in accordance with the licensing rules of the facility. This Rule is not met as evidenced by:

OAR 411-057-0160(2)(c)(A)(B) Nutrition and Hydration (c) A daily meal program for nutrition and hydration must be provided based upon the resident ' s preferences and needs available throughout each resident ' s waking hours. The individualized nutritional plan for each resident must be documented in the resident ' s service or care plan. In addition, the memory care community must provide: (A) Visual contrast between plates, eating utensils, and the table to maximize the independence of each resident; and (B) Adaptive eating utensils for those residents who have been evaluated as needing them to maintain their eating skills. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure individualized nutrition and hydration plans for each resident were developed and included in the service plans for 2 of 3 sampled residents (#s 1 and 2) residing in the MCC. Findings include, but are not limited to: Resident’s 1 and 2’s clinical record including current service plans were reviewed during the survey and identified the following: • Both residents had a history of weight loss; and • Service plans lacked an individualized nutrition and hydration plan. The need to develop an individualized nutrition and hydration plan for the resident and include the information in the resident's service plan was reviewed with Staff 1 (ED), Staff 2 Memory Care Director), Staff 4 (Health Services Director, LPN) and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 11:57 am. They acknowledged the findings.

1. Resident 1 and 2's service plan were reviewed and updated with nutrition and hydration preferences. 2. Service plans will be reviewed and updated to reflect current preferences including interventions to maintain nutrition and hydration plans. These will then be reviewed quarterly, as needed, and with significant change in condition. ISP's will be completed providing clear direction for the care staff to follow current interventions. 3. Individualized Nutritional and Hydration plans will be developed upon admission and updated into the resident's service plans. Continued review of these plans will be conducted, quarterly and with change of condition. This process will be audited during monthly CQI meetings. 4. Memory Care Administrator, Executive Director, Direcotr of Health Services, RN, and Dietary Manager will be responsible for maintaining this system.

OAR 411-057-0160(2)(c)(A)(B) Nutrition and Hydration (c) A daily meal program for nutrition and hydration must be provided based upon the resident ' s preferences and needs available throughout each resident ' s waking hours. The individualized nutritional plan for each resident must be documented in the resident ' s service or care plan. In addition, the memory care community must provide: (A) Visual contrast between plates, eating utensils, and the table to maximize the independence of each resident; and (B) Adaptive eating utensils for those residents who have been evaluated as needing them to maintain their eating skills. This Rule is not met as evidenced by:

OAR 411-057-0160(2d) Activities (d) Meaningful activities that promote or help sustain the physical and emotional well-being of residents. The activities must be person centered and available during residents ' waking hours. (A) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (i) Past and current interests; (ii) Current abilities and skills; (iii) Emotional and social needs and patterns; (iv) Physical abilities and limitations; (v) Adaptations necessary for the resident to participate; and (vi) Identification of activities for behavioral interventions. (B) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident ' s activity preferences and needs. (C) A selection of daily structured and non-structured activities must be provided and included on the resident ' s activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (i) Occupation or chore related tasks; (ii) Scheduled and planned events (e.g. entertainment, outings); (iii) Spontaneous activities for enjoyment or those that may help diffuse a behavior; (iv) One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); (v) Spiritual, creative, and intellectual activities; (vi) Sensory stimulation activities; (vii) Physical activities that enhance or maintain a resident ' s ability to ambulate or move; and (viii) Outdoor activities. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to evaluate and develop individualized activity plans for 3 of 3 sampled residents (#s 1, 2, and 3) whose activity plans were reviewed. Findings include, but are not limited to: a. Resident 1, 2, and 3’s records were reviewed during the survey. There was no documented evidence an activity evaluation had been completed and including the follow required information: * Past and current interests; * Current abilities and skills; * Emotional and social needs and patterns; * Physical abilities and limitations; * Adaptations necessary for the resident to participate; and * Identification of activities for behavioral interventions. b. Resident 1, 2 and 3 lacked an individualized activity plan that was based on their activity evaluation and reflected activity preferences and needs including daily structured and non-structured activities that include but are not limited to the following: * Occupation or chore related tasks; * Scheduled and planned events (e.g. entertainment, outings); * Spontaneous activities for enjoyment or those that may help diffuse a behavior; * One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); * Spiritual, creative, and intellectual activities; * Sensory stimulation activities; * Physical activities that enhance or maintain a resident 's ability to move or ambulate; and * Outdoor activities. On 12/12/24 at 11:57 am, the lack of an activity evaluation and individualized activity plan was discussed with Staff 1 (ED), Staff 2 Memory Care Director), Staff 4 (Health Services Director, LPN) and Staff 6 (Vice President of Clinical Services). They acknowledged the findings.

1. Residents 1, 2 and 3 service plans have been updated with individualized activity plans. 2. 'Conections Profile' evaluation has been implemented to address developing individualized activity plans for Memory Care residents. Training has been conducted with Health Services Team and Life Enrichment Director on developing and implementing Individualized Activity plans. 3. At Move in, 30 days, quarterly and with change of condition. 4. Arbor Administrator, Life Enrichment Director

OAR 411-057-0160(2d) Activities (d) Meaningful activities that promote or help sustain the physical and emotional well-being of residents. The activities must be person centered and available during residents ' waking hours. (A) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (i) Past and current interests; (ii) Current abilities and skills; (iii) Emotional and social needs and patterns; (iv) Physical abilities and limitations; (v) Adaptations necessary for the resident to participate; and (vi) Identification of activities for behavioral interventions. (B) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident ' s activity preferences and needs. (C) A selection of daily structured and non-structured activities must be provided and included on the resident ' s activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (i) Occupation or chore related tasks; (ii) Scheduled and planned events (e.g. entertainment, outings); (iii) Spontaneous activities for enjoyment or those that may help diffuse a behavior; (iv) One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); (v) Spiritual, creative, and intellectual activities; (vi) Sensory stimulation activities; (vii) Physical activities that enhance or maintain a resident ' s ability to ambulate or move; and (viii) Outdoor activities. This Rule is not met as evidenced by: