The findings of the kitchen inspection, conducted 07/21/23, 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 revisit to the kitchen inspection of 07/21/23, conducted 09/22/23, 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 second re-visit to the kitchen re-licensure survey of 09/22/23, conducted 01/11/24, 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 clean and in good repair, ensure meals were prepared and served at appropriate temperatures and were palatable, and food was in accordance with the Food Sanitation Rules, OAR 333-150-0000. Findings include, but are not limited to:

Observations of the primary kitchen and assisted living dining room on 07/21/23 from 10:00 am through 3:15 pm identified the following deficiencies:

a. Observations and interviews with Staff 2 (Dietary Services Manager), Staff 3 (Cook), and Staff 4 (Cook) identified a lack of demonstrated knowledge of foodborne disease prevention including cross contamination and safe food handling processes.

b. Food storage:

* Multiple refrigerated foods were not properly labeled, dated and covered;

* Multiple food items were not shelved to allow air circulation;

* Food was not properly shelved in the walk-in refrigerator (uncooked eggs were shelved with vegetable and leafy greens and boiled eggs were shelved with tortillas);

* Walk-in freezer had multiple food items stored directly on the floor;

* One gallon jug of lemon juice was expired;

* One gallon soy sauce was not refrigerated after opening (stored on lower shelf next to oven);

* One gallon jug of red vinaigrette dressing was not refrigerated after opening (stored on shelf below server side of steam table);

* Multiple open packages of noodles in the dry storage area;

* Open package of marshmallows on the shelf above the two compartment sink; and

* Cake frosting and plastic to-go clamshell containers were stored on the window sill.

c. Food preparation and service:

* Staff 2, 3 and 4 failed to use a probe thermometer to temperature the food items before serving. Staff 4 was unable to state proper cooking times and temperatures;

* Observation of meat thawing on top shelf in the walk-in refrigerator and chicken breast thawing in a cardboard box;

* Clam chowder soup was not properly cooled;

* Staff were not able to identify potentially hazardous foods;

* Cross contamination of beef product and onions; and

* Staff failed to have knowledge of and use color coded cut boards properly (to prevent cross contamination);

* Pizza slice fell off the plate and was picked up with gloved hands and placed back on the plate;

* Tongs were not used to handle cut slices of pizza when plated;

* Ready-to-eat garden salad was expired;

* Staff 4 failed to properly mix nectar thick consistent clam chowder for one resident;

* Plates were carried by hand, not on trays, and were not covered during transportation to residents eating in the dining room;

* Residents who requested tray service to their rooms were served on Styrofoam or other paper product, had smaller portions and were not served lunch until 1:15 pm or later; and

* Staff failed to take many resident lunch orders which required the kitchen staff to guess what food option the resident might want to eat.

The surveyor requested the kitchen staff to take the food temperatures and to remove the expired garden salad from the tray line. Staff 2 (Dietary Services Manager) removed the expired salad and began taking temperatures. The temperatures were as follows:

* Potato salad in a cardboard container was stored on the server side of the steam table. Prior to the beginning of food service the potato salad temperature was 41.3 degrees F. and rising;

* Canned peaches 69 degrees F.;

* Tomato juice 64.2 degrees F.;

* Chocolate milk 59 degrees F.; and

* White milk 46.9 degrees F.;

Staff 2 began ice bathing and cooling food below 41 degrees F. prior to starting food service again.

d. Sanitation and infection control:

* On multiple occasions cooks failed to change gloves and perform hand hygiene between dirty and clean tasks and between touching different food items;

* Staff 5 (Dishwasher) failed to wash hands between handling dirty dishes and putting away clean dishes;

* Sanitation buckets and wiping cloths were not changed from 10:00 am and 3:00 pm;

* Staff failed to wear aprons; and

* Staff failed to restrain beard hair.

e. An accumulation of food spills, splatters, loose food, dirt, and dust was observed on or underneath the following:

* The serving counter, cabinets and drawers in the dining room;

* The juice and coffee countertop and lower shelf;

* Dry food storage floor;

* Walk-in refrigerator and freezer floors;

* Floor tiles throughout the entire kitchen;

* Janitorial closet was disorganized and the closet door was not closed;

* Ice scoop holder hanging on the wall;

* Multiple floor drains;

* Wall above and below the warewash machine;

* Hobart mixer;

* Microwave inside and outside;

* Two hand-mixers stored on the window sill had an accumulation of dust;

* Toaster had accumulation of food crumbs and grease on the inside and outside of the appliance;

* Upright reach-in refrigerator (near the entrance of the kitchen) had food splatter on the outside and inside;

* Vulcan oven had an accumulation of food matter and grease buildup on the inside and outside of the oven;

* Hood vents above oven;

* Multiple buckets of used food grease was stored in uncovered buckets next to the oven;

* Floor fan blades and cage; and

* Metal storage rack (near the warewash machine) that stored clean dishes had a buildup of dirt and dust debris.

b. The following areas were found in need of repair:

* Vulcan oven grease trap was leaking;

* Metal stool was rusted;

* Multiple trash can lids had the circle opening modified which created an enlarged hole in the top of the lid;

* Baseboard floor tile missing near ice machine;

* Floor tile missing near drain under two compartment sink; and

* Salad bar counter/cooler (located in the dining room) was inoperable.

The kitchen was toured and the need to ensure the kitchen was maintained in accordance with Oregon food sanitation rules and food was palatable and served at proper temperatures was discussed with Staff 1 (ED) and Staff 2 at 3:15 pm. They acknowledged the above findings and immediately discarded the buckets of used food grease that were stored next to the oven.

a. Resident Services Meals, Food Sanitation Rule

1. Reviewed noted findings regarding food sanitation and foodborne illness prevention with all staff at the dietary staff meeting.  All dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.

2.  All food service staff will be trained upon hire on safe food handling, prevention of food borne illness and cross contamination.

3. Dietary Manager will review and audit staff training and comprehension as part of the monthly CQI meeting.

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.

b. Food Storage

1. Dietary manager and food service staff, immediately mitigated all items identified at time of survey and on SOD.  Reviewed all items identified during survey, at the monthly dietary staff meeting.  All food was discarded or labeled, dated and covered, as appropriate; food was adjusted on shelving to allow for air circulation; uncooked and boiled eggs were moved to their proper shelf; food items on floor of walk in, items stored improperly were moved to their designated locations; identified expired and unrefrigerated items were discarded.

2. All dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training. Dietary manager will review and audit food storage requirements at monthly dietary staff meeting.  All food service staff will be trained on proper food storage, preparation, service, sanitation and infection control, as part of the new hire process.

3. Dietary Manager will review and audit staff training and comprehension as part of the monthly CQI meeting. Weekly food orders will be shelved to their proper location immediately once delivered.

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.  

c. Food Preparation and Service

1. Reviewed findings found during survey, regarding food sanitation and foodborne illness prevention with all staff at the dietary staff meeting.  Color coded cutting boards are properly labeled and a guide to coding is now located on wall above prep table.  Ice bath in place for any item that requires refrigeration; Temperatures taken and added to the temperature log.  Changed apartment meal ordering from weekly to daily; daily meal orders are now taken by care staff the night before, instead of a week in advance. Room trays will be delivered to resident apartment within the parameters of the respective meal times.

2. All dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training. All current food service staff will be trained on proper food storage, preparation, service, sanitation and infection control, and as part of the new hire process. Dietary staff will be trained on proper use of thickening solutions as well as modified diets.  

3. Dietary Manager will review and audit staff training and comprehension as part of the monthly CQI meeting. Dietary Manager will audit system at least weekly and will monitor response from residents at the monthly food committee meeting. Food temperatures are taken and logged for each meal and item on service.

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.

d. Sanitation and Infection Control

1. Reviewed findings at time of survey, regarding sanitation and infection control with all staff at the dietary staff meeting.  All dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.  

2. All food service staff will be trained upon hire on safe food handling, prevention of food borne illness and cross contamination.

3.  Dietary Manager will review and audit staff training and comprehension as part of the monthly CQI meeting.  

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.

e.  Spills, Splatters, Dust and Dirt

1. Reviewed findings with both dietary staff and Maintenance Director. Deep cleaning has begun on all areas identified on SOD.  Deep cleaning of all floors is scheduled.  Daily kitchen cleaning checklist will be performed by all areas of kichen staff.  Cleaning checklist to include shelves, microwave, walk-in refrigerator and freezer, toaster, reach-in refrigeratorand oven.  Hood vents are scheduled to be professionally cleaned.  Ice scoop holder fixed and floor fan and metal storage to be powerwashed by Maintenance Director.  All current dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.

2. All dietary staff have a cleaning schedule that they will be responsible for, based on shift and position.  All new dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.

3.  Daily checklists will be monitored weekly and more often as needed by Dietary Manager.  Dietary Manager will review and audit staff training and comprehension as part of the monthly CQI meeting.

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.

b. (f) Repairs

1. Reviewed findings with Maintenance Director and schedule has been created to complete all repairs.

2. Maintenance Director will add kitchen to walking rounds.  All dietary staff will be inservcied on the work order system through TELS to identify areas needing repair timely.  All current dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.

2. Dietary Manager and Maintenance Director will review and audit staff training and comprehension as part of the monthly CQI meeting. All new dietary staff will complete an inservice and post-test based on the CBC Provider Kitchen Inspection training.

4. Executive Director and Dietary Manager are responsible to see that all corrections are completed and monitored.

Based on observation and interview, it was determined the facility failed to maintain the kitchen clean and in good repair in accordance with the Oregon Food Sanitation Rules, OAR 333-150-0000, failed to ensure food was palatable, and all residents were served meals with dignity. This is a repeat citation. Findings include, but are not limited to:

Observations of the primary kitchen and assisted living dining room on 09/22/23 from 10:10 am through 1:58 pm identified the following:

a. Food preparation, service and infection control:

* The facility lacked a sufficient number of plate lids to cover all the resident's plates during distribution;

* Multiple staff failed to use tongs or other utensil when handling pre cooked dinner rolls and pre-cooked tortilla shells;

* Staff 3 (Cook) failed to properly puree the meal (clam chowder, rice and broccoli were all blended together) for one resident;

* Staff 4 (Cook) failed to properly wash and prepare produce (broccoli) prior to cooking; and

* Residents who requested tray service to their rooms were served on Styrofoam or other paper product, were not served utensils, had smaller portions and were not served lunch until 12:58 pm or later. The lunch meal service began at 11:30 am.

b. Cold food items including lettuce, tomatoes and cheese were taken out of the walk in refrigerator at 11:07 am and the temperature was taken at 11:25 am and were above the maximum 41 degrees F. Staff 4 put the food back in the walk-in refrigerator to reduce the temperature prior to plating the food. This delayed the meal service until 11:58 am.

c. An accumulation of food spills, splatters, loose food, dirt, and dust was observed on or underneath the following:

* Janitorial closet was disorganized and staff were not able to safely access the janitor tub and disinfectant hanging on the wall;

* Ice scoop holder hanging on the wall had a build up of brown matter;

* Ice machine vent on the left side of the machine had a buildup of dust;

* Wall to the left of the of the ice machine was covered with a build up of dust debris;

* Multiple floor drains; and

* Wall to the right side of the warewash machine had a build up of black matter where the wall and the stainless steel wash counter meet.

d. The following areas were found in need of repair:

* Salad bar counter/cooler (located in the dining room) was inoperable; and

* Cabinet doors of the cereal counter in the dinning room had gouges, scuffs and hinges were broken or loose preventing the cabinet doors to completely close.

The need to ensure the kitchen was maintained in accordance with Oregon food sanitation rules, food was palatable and all residents were served meals with dignity was discussed with Staff 2 (Dietary Services Manager) and Staff 6 (ED)  at 1:00 pm. They acknowledged the above findings.

A. Food preparation, service, and infection control:

1.Lack of lids and utensils, dietary manager order products to ensure we have plenty of plates, lids, and utensils per serve out need.

2. Cook trained of how to properly prep puree meals for residents to show main and sides in different dishwares. Training for the proper wash sink for all fresh produce with a sign hung up for cooks to see.

3. Tray service: staff trained on how to serve 1 floor at a time to ensure residents are served timely and with proper temped food.

4. Cold food items are to stay in the refrigerator to ensure prior to serve outs to ensure food stays at temp. Servers trained on proper food temps.

- Dietary Manager is to review Kitchen Audit tool monthly and review with Executive Director.

Executive Director and dietary manager are responsible to ensure corrections and monitoring.

B. An accumlation of food spills, splatters, loose food, dirt, and dust was observed on or underneath.

1. Janitoral closet disorganization was then organized, and staff trained on the proper look of the janitoral closet that will be monitored daily

2. Ice scoop holder hanging on the wall, was replaced with a enclosed ice scoop holder and is added to a daily cleaning task.

3. Ice machine vent on the left side of the machine that had build up was cleaned, and added to the monthly cleaning task list.

4. Floor drains are cleaned nightly and added to the daily cleaning task list.

5. Wall to the right side of the warewash machine had a build up of black matter where the wall and stainless steel wash counter meet was cleaned and recalked by maintenance director and added to the daily cleaning tasks.

- Dietary Manager is to review Kitchen Audit tool monthly and review with Executive Director.

Executive Director and dietary manager are responsible to ensure corrections and monitoring.

C. In need of repair

1.Salad bar counter/cooler was inoperable was removed from the counter.

2. cabinet doors of the counter in the dining room had gouges, scuffs, and hinges were broken, maintenance director has removed and repaired cabinet doors.

3. Dietary manager was trained on how to enter maintenance work order needs to ensure kitchen repairs are done in a timely manner.

Dietary Manager is to review Kitchen Audit tool monthly and review with Executive Director.

Executive Director and dietary manager are responsible to ensure corrections and monitoring.

Based on observation and interview, it was determined the facility failed to ensure the re-licensure survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to:

Refer to C240.

Refer to C240