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' care needs and preferences, provided clear direction to staff regarding the delivery of services and were implemented for 1 of 2 sampled residents (#2) whose service plan was reviewed. Findings include, but are not limited to: Resident 2 moved into the facility in 03/2026 with diagnoses including dementia. Observations of the resident, interviews with staff, and review of the service plan, dated 07/14/26, and subsequent temporary service plans (TSP’s) identified the following: a. The service plan was not reflective of the resident's current care needs and preferences and lacked clear direction to staff in the following areas: * Risks and precautions related to the use of bilateral siderails; * Food and fluid preferences; * Social and recreational preferences; * Oral care; * Two-person assistance for bowel and bladder management, including incontinence care received in bed and/or preference to use the bathroom; and * Behavior care plan. b. The service plan was not implemented in the following area: * Swallowing and choking precautions and reposition the resident to a 90-degree angle while eating in bed. Observations during the lunch meal service on 08/11/26 and 08/12/26 identified the resident was in bed eating with the head of the hospital bed lifted to a 40-to-45-degree angle. The need to ensure resident service plans were reflective of current care needs and preferences, provided clear directions to staff, and were implemented was discussed with Staff 1 (Administrator), Staff 2 (Director of Nursing), Staff 3 (RN), and Staff 10 (RCC) on 08/13/26 at 11:30 am. They acknowledged the findings.

C0260 1. Service plan for #2 has been updated to reflect current resident care needs and meal and fluid preferences. Staff education was provided on bilateral side rail risks and precautions, with TSPs implemented as appropriate. Staff and resident were also educated on swallowing and choking precautions related to bed position. Resident does not have a behavioral plan at this time. Ongoing staff direction and monitoring will ensure continued compliance. 2. All Servies plans will be reviewed by Admin, RCC and LN prior to implementing for staff. 3.Services plans will be audited weekly x2 and Monthly x2, quarterly there after 4.Admin and LN , and RCC

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:

OAR411-004-0020(1)(a)(B) Integrated Settings: Community Life (1) Residential and non-residential HCB settings must have all of the following qualities: (a) The setting is integrated in and supports the same degree of access to the greater community as people not receiving HCBS, including opportunities for individuals enrolled in or utilizing HCBS to: (B) Engage in greater community life; This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure the memory care setting supported the same degree of access to the greater community as those not receiving home and community-based services (HCBS), including opportunities to engage in greater community life, for 1 of 1 resident (#2) who was unable to exit the facility independently. Findings include, but are not limited to: Resident 2 moved into the facility in 03/2026 with diagnoses including dementia. During the acuity interview, the resident was identified as needing the assistance of two care staff and a gait belt with transfers at all times and was at risk for falls. During an interview with Resident 2 on 08/13/26 at 9:35 am, it was reported that the facility did not provide him/her the opportunity to participate in activities outside of the secured memory care. The resident reported, “I’ve even asked them to push me around the block, get some fresh air, they tell me it’s not their job.” The resident stated s/he could go out with family members, however, “it is too difficult because my legs are too long to get into [family member’s] car, so I’m here, stuck.” Review of the resident’s current evaluation and service plan, dated 07/14/26, and an undated activity evaluation showed the facility failed to evaluate and service plan the resident’s social and recreational activities and interest to participate in activities outside of the secured memory care. During an interview with Staff 2 (Director of Nursing) on 08/13/26 at 11:30 am, it was reported the facility had access to take people on activities outside of the secured memory care; however, there was no documented evidence that the facility offered this service to Resident 2. The need to ensure the memory care setting supported the same degree of access to the greater community as those not receiving home and community-based services (HCBS), including opportunities to engage in greater community life, was reviewed with Staff 1 (Administrator), Staff 2, Staff 3 (RN), and Staff 10 (RCC) on 08/13/26 at 11:30 am. They acknowledged the findings.

H1501 1. Activities, outings and alternatives are documented in each residents record, activity evaluations have been completed to reflect Resident #2 resident-centered interests such as Poker, pugs and Jazz music. Group outings/alternatives and preferences will be offered as service planned. Evaluations will be updated quarterly to ensure activities remain resident-centered and consistent with #2 current service plans. Activities and alternatives are documented in the eMAR system. 2.Will implement daily documentation for all residents in e-mar system. 3.Weekly x2, Monthly x2, Silent Audit of communication between staff and residents 4. Admin

OAR411-004-0020(1)(a)(B) Integrated Settings: Community Life (1) Residential and non-residential HCB settings must have all of the following qualities: (a) The setting is integrated in and supports the same degree of access to the greater community as people not receiving HCBS, including opportunities for individuals enrolled in or utilizing HCBS to: (B) Engage in greater community life; This Rule is not met as evidenced by:

OAR411-004-0020(1)(c) Individual Rights Settings: Privacy, Dignity (1) Residential and non-residential HCB settings must have all of the following qualities: (c) The setting ensures individual rights of privacy, dignity, respect, and freedom from coercion and restraint. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to have a setting that ensured individual rights to receive services with dignity and respect. Findings include, but are not limited to: Resident 2 moved into the facility in 03/2026 with diagnoses including dementia. During the acuity interview on 08/11/26, the resident was identified as needing two care staff to assist with transfers and all ADL care. Review of the resident’s clinical record, interviews with and observations of the resident and staff identified the facility failed to ensure the resident received services with dignity and respect in the following areas: a. During review of the resident’s current service plan, dated 07/14/26, the following was noted: * Will need assistance with completing [his/her] sentences as [s/he] will “space out.”; and * Will need assistance with “placing a bib on.” b. During an interview and observation with the resident on 08/13/26 at 9:35 am the following was observed: Two care staff came into Resident 2’s room to provide care and were observed talking in English with the resident. The care staff then began speaking in another language. The resident’s body language and facial expressions changed. When the care staff left the room the resident stated it was “frustrating, they talk [another language], I don’t know what they say. I’ve told them before not to do that, to speak English, and they keep doing it.” The resident further reported s/he prefers to use the bathroom, but “they have this diaper on me and say they need to change me in bed; I’m not a child, I’m a 73-year-old [gender].” c. During an interview with Staff 11 (CG) on 08/12/26 at 12:05 pm, the care staff repeatedly referenced Resident 2 needed assistance changing his/her “diaper.” The need to ensure the facility had a setting that ensured individual rights to receive services with dignity and respect was discussed with Staff 1 (Administrator), Staff 2 (Director of Nursing), Staff 3 (RN), and Staff 10 (RCC) on 08/13/26 at 11:30 am. They acknowledged the findings.

H1510 1. Communication will be respectful, resident-centered, and provided in each resident’s preferred language. It was updated to reflect resident #2 service plan. Staff will receive education on preferred language, appropriate communication, and elderspeak. Service plans will reflect each resident’s communication needs and language preferences. 2.Will have an inservice provided by Admin addressing proper communication and langauge use between staff and residents 3.Weekly x2, Monthly x2, Silent Audit of communication between staff and residents 4. Admin

OAR411-004-0020(1)(c) Individual Rights Settings: Privacy, Dignity (1) Residential and non-residential HCB settings must have all of the following qualities: (c) The setting ensures individual rights of privacy, dignity, respect, and freedom from coercion and restraint. 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.

Z0162 Referral, see POC for C260.

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: