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 determine actions or interventions needed, communicate actions or interventions to staff on all shifts, and monitor changes through resolution with at least weekly documentation for 2 of 2 sampled residents (#s 1 and 2) reviewed with short-term changes of condition. Findings include, but are not limited to: 1. Resident 2 was admitted to the facility in 02/2025 with diagnoses which included Alzheimer’s disease and schizoaffective disorder. The resident’s clinical record, including progress notes from 09/19/25 through 11/17/25 were reviewed, observations were made, and staff were interviewed during the survey. a. A review of the resident’s clinical record indicated the resident experienced the following: * 11/02/25-non-injury fall; * 11/03/25-non-injury fall; * 11/07/25-two falls with injuries, abrasion to right toe and abrasions to both knees; * 11/08/25-fall with abrasion to forehead; and * 11/14/25-fall with abrasion to right knee. There was no documented evidence the facility determined, documented, and communicated to staff what actions or interventions were needed and failed to document weekly progress of the resident’s mobility and injuries until the conditions resolved. On 11/18/25 at 12:15 pm, Staff 3 (Memory Care Coordinator/LPN) acknowledged there were no actions and/or interventions communicated to staff regarding Resident 2’s falls. b. A review of the resident’s clinical record indicated the following medication changes: * 10/14/25 - Discontinue lamotrigine 100mg (anti-seizure medication); * 10/28/25 - New medication methadone 2.5mg (for pain); * 11/04/25 - Increase methadone to 5mg (for pain); increase duloxetine from 30mg to 60mg (for mood stabilization); and new medication haloperidol 1mg (for mood stabilization); * 11/06/25 - Increase haloperidol to 2mg (for mood stabilization); * 11/08/25 - New medication, valproic acid 250mg/ml (for hallucinations/agitation); and * 11/11/25 – New PRN medication, triamcinolone cream (to treat skin conditions). There was no documented evidence these short-term changes of condition were monitored, with progress noted at least weekly, to resolution. On 11/18/25 at 1:20 pm, Staff 2 (Resident Services Coordinator/RN) and Staff 3 (Memory Care Coordinator/LPN) confirmed the identified changes of condition for medications, and they acknowledged the lack of documented monitoring through resolution. The need to ensure the facility determined and documented what actions or interventions were needed for changes of condition, communicated the actions or interventions to staff on all shifts, and monitored the short-term changes of condition at least weekly through resolution was discussed with Staff 1 (ED), Staff 2, and Staff 4 (Behavioral Support Specialist) on 11/19/25. They acknowledged the findings. No additional documentation was provided. 2. Resident 1 was admitted to the facility in 06/2024 with diagnoses including late onset Alzheimer’s disease and dementia. The resident’s 08/21/25 through 11/05/25 progress notes, temporary service plans (TSPs), and interim service plans (ISPs) were reviewed, and staff were interviewed. The following was identified: * 08/21/25 – Memantine 10 mg tab (for dementia); give half (5 mg) twice daily for seven days then discontinue; * 09/11/25 – Discontinue erythromycin 5 mg (an antibiotic), memantine 10 mg twice daily (for Alzheimer’s disease), and sertraline 100 mg (an anti-depressant); * 09/12/25 – Start new medications, including acetaminophen 325 mg (for pain), bisacodyl suppository (for constipation), bupropion (an anti-depressant), cetirizine (for allergies), haloperidol (an anti-psychotic), lorazepam (for anxiety or agitation), mirtazapine (a mood stabilizer), morphine (for pain), paroxetine (a mood stabilizer), polyethylene glycol (for constipation), risperidone (a mood stabilizer), and senna (for constipation). Discontinue as-needed acetaminophen, “alum and mag” (an antacid), Milk of Magnesia (for constipation), and nystatin (an antifungal medication); and * 10/06/25 – Discontinue bupropion (an anti-depressant). There was no documented monitoring of these short-term changes of condition through resolution. In an interview on 11/19/25 at 12:55 pm, Staff 3 (Memory Care Coordinator/LPN) stated she was not sure why some TSPs/ISPs got resolved and some didn’t. She stated she was trying to figure out a system that would ensure all short-term changes of condition were monitored through resolution. The need to monitor short-term changes of condition through resolution, with at least weekly progress documented, was discussed with Staff 1 (ED), Staff 2 (Resident Services Coordinator/RN), and Staff 4 (Behavioral Support Specialist) on 11/19/25 at 2:30 pm. They acknowledged the findings.

1) Residents presenting with any short term change or incidents will be doccumented with a TSP or ISP. TSP and ISP will be individualized to fit individual residents needs. Resident's status will be documented in progress notes until resolved and removed off of alert charting. 2) Resident TSP and ISP will be individualized to fit each residents needs and reviewed by Resident Service Coordinator until resolved. Care staff and Med techs will review and sign ISP or TSP at beginning of each shift. 3)TSP and ISP sign off sheets will be audited weekly by Resident Service Coordinator. Weekly and until resolved and closed out 4) Resident Service Coordinator, Executive Director

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 411-054-0055 (1)(e) Systems: Tracking Control Substances (e) The facility must have a system approved by a pharmacist consultant or registered nurse for tracking controlled substances and for disposal of all unused, outdated or discontinued medications administered by the facility. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to have a system in place for accurately tracking controlled substances administered by the facility for 1 of 1 sampled resident (# 2) whose MARs and Controlled Substance Drug Disposition logs were reviewed for accuracy. Findings include, but are not limited to: Resident 2 was admitted to the facility in 02/2025 with diagnoses which included Alzheimer’s disease and schizoaffective disorder. The resident's 11/01/25 through 11/17/25 MARs and physician orders were reviewed. The following was identified: The resident had an order for morphine (narcotic analgesic) 20 mg/ml every hour as needed for pain. * The 11/01/25 through 11/17/25 MAR revealed the resident was administered the PRN narcotic on nine on occasions. * The Controlled Substance Distribution log contained 13 entries for 11/2025. Four of the 13 entries in the controlled substance log were not reflected on the MAR. * The number of milliliters remaining noted in the Controlled Substance Distribution log matched the number of milliliters remaining in the corresponding medication bottle. Inconsistencies between the MAR and Controlled Substance Disposition Log were reviewed with Staff 3 (Memory Care Coordinator/LPN) on 11/19/25 at 9:30 am. She reviewed the documentation and acknowledged the discrepancy. The need to ensure a system was in place for tracking controlled substances was discussed with Staff 1 (ED), Staff 2 (Resident Services Coordinator/RN), and Staff 4 (Behavioral Support Specialist) on 11/19/25. They acknowledged the findings.

1) MAR's and Narc book will be audited by Facility RN weekly. All Medication Aids will be retrained and will take an Oregon Care Partners Course, Medication Administration Training for Unlicensed Medication Technicians. 2) Medication Aids will be trained through Oregon Care Partners. MAR's and Narc book will be audited routinly. 3)Mar's and Narc book will be audited by Facility RN weekly and by RDO monthly. 4)Resident Service Director/RN, Regional Director of Operations, Executive Director

OAR 411-054-0055 (1)(e) Systems: Tracking Control Substances (e) The facility must have a system approved by a pharmacist consultant or registered nurse for tracking controlled substances and for disposal of all unused, outdated or discontinued medications administered by the facility. This Rule is not met as evidenced by:

OAR 411-054-0070 (5 & 9-10) Training Within 30 Days of Hire – Direct Care Staff (5) TRAINING WITHIN 30 DAYS OF HIRE FOR DIRECT CARE STAFF. (a) The facility is responsible to verify that direct care staff have demonstrated satisfactory performance in any duty they are assigned. (b) Knowledge and performance must be demonstrated in all areas within the first 30 days of hire, including, but not limited to: (A) The role of service plans in providing individualized resident care. (B) Providing assistance with the activities of daily living. (C) Changes associated with normal aging. (D) Identification of changes in the resident's physical, emotional and mental functioning and documentation and reporting on the resident's changes of condition. (E) Conditions that require assessment, treatment, observation and reporting. (F) General food safety, serving and sanitation. (G) If the direct care staff person’s duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) must document that they have observed and evaluated the individual’s ability to perform safe medication and treatment administration unsupervised. (9) ADDITIONAL REQUIREMENTS. Staff: (a) Under 18 years of age may not perform medication administration or delegated nursing tasks. Staff under the age of 18 must be directly supervised when providing bathing, toileting, incontinence care or transferring services. (b) Must be trained in the use of the abdominal thrust and First Aid. Cardiopulmonary resuscitation (CPR) training is recommended, but not required. (c) Must have sufficient communication and language skills to enable them to perform their duties and communicate with residents, other staff, family members, and health care professionals, as needed. (10) Contractors who provide services or supports directly to residents must complete the required LGBTQIA2S+ trainings outlined in paragraph (6)(b)(C) of this rule. (a) Contractors who must be trained include, but are not limited to, RN and administrative consultants, housekeeping services, dietary services, beauticians, barbers, or other contractors who provide services or supports directly to residents. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure 3 of 4 newly hired direct care staff (#s 9, 10, and 11) demonstrated competency in first aid and abdominal thrust within 30 days of hire. Findings include, but are not limited to: Training records were reviewed on 11/18/2025, and the following was identified: There was no documented evidence that Staff 9 (MT/CG), hired 08/04/25, Staff 10 (CG), hired 08/06/25, and Staff 11 (CG), hired 09/18/25, had demonstrated competency in first aid and abdominal thrust within 30 days of hire. The need to ensure staff demonstrated competency in all assigned duties within 30 days of hire was discussed with Staff 1 (ED), Staff 2 (Resident Services Coordinator/RN), and Staff 4 (Behavioral Support Specialist) on 11/19/25 at 2:30 pm. They acknowledged the findings.

New hire packets will be update for compliance with required training. Caregiver check off sheet will be audited prior to staff working with residents. Staff files will be audited qurterly for staff training compliance. Staff noted during survey have been trained on First Aid and Abdominal Thrust. 2) Caregiver worker check off sheets completed 3) Prior to Caregivers completing initial training, Staff files will be audited qurterly for staff training compliance. 4) Maple Valley Office Assistant, Executive Director

OAR 411-054-0070 (5 & 9-10) Training Within 30 Days of Hire – Direct Care Staff (5) TRAINING WITHIN 30 DAYS OF HIRE FOR DIRECT CARE STAFF. (a) The facility is responsible to verify that direct care staff have demonstrated satisfactory performance in any duty they are assigned. (b) Knowledge and performance must be demonstrated in all areas within the first 30 days of hire, including, but not limited to: (A) The role of service plans in providing individualized resident care. (B) Providing assistance with the activities of daily living. (C) Changes associated with normal aging. (D) Identification of changes in the resident's physical, emotional and mental functioning and documentation and reporting on the resident's changes of condition. (E) Conditions that require assessment, treatment, observation and reporting. (F) General food safety, serving and sanitation. (G) If the direct care staff person’s duties include the administration of medication or treatments, appropriate facility staff, in accordance with OAR 411-054-0055 (Medications and Treatments) must document that they have observed and evaluated the individual’s ability to perform safe medication and treatment administration unsupervised. (9) ADDITIONAL REQUIREMENTS. Staff: (a) Under 18 years of age may not perform medication administration or delegated nursing tasks. Staff under the age of 18 must be directly supervised when providing bathing, toileting, incontinence care or transferring services. (b) Must be trained in the use of the abdominal thrust and First Aid. Cardiopulmonary resuscitation (CPR) training is recommended, but not required. (c) Must have sufficient communication and language skills to enable them to perform their duties and communicate with residents, other staff, family members, and health care professionals, as needed. (10) Contractors who provide services or supports directly to residents must complete the required LGBTQIA2S+ trainings outlined in paragraph (6)(b)(C) of this rule. (a) Contractors who must be trained include, but are not limited to, RN and administrative consultants, housekeeping services, dietary services, beauticians, barbers, or other contractors who provide services or supports directly to residents. 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 C372.

Refer to C 372

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 C270 and C302.

Refer to C 270 and C302

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: