Print Inspection: 370W

The findings of the kitchen inspection, conducted 06/03/24, 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 and OARs 411 Division 57 for Memory Care Communities.

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

The findings of the revisit to the kitchen inspection of 06/03/24, conducted 09/09/24, 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 and OARs 411 Division 57 for Memory Care Communities.

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

The kitchen was toured with Staff 2 (Kitchen Manager) on 06/03/24.

Observations of the facility's kitchen, food storage areas, food preparation, and food service on 06/03/24 revealed:

* Splatters, spills, stains, and debris noted on:

- Hand washing sink;

- Can opener blade and casing;

- Wire rack storage shelves in walk-in refrigerator, walk in freezer, and throughout the kitchen;

- Open shelving throughout the kitchen;

- Walls throughout the kitchen;

- Floors in walk-in refrigerator, walk-in freezer, throughout the kitchen,  cove base, and drains;

- The dishwashing area walls, floors, and equipment;

- Both sides of the range, grill, and oven;

- Standing mixer;

- Carts;

- Free standing air conditioner;

- Interior of drawers in main kitchen and Memory Care dining room; and

- Cabinet fronts in the Memory Care dining room.

* Walls, shelving, flooring, and cove base through the kitchen was damaged, creating un-cleanable surfaces.

* The plastic cutting board attached to the steam table were deeply scored and stained black.

* There was an approximately 2 foot wooden cutting board attached to the steam table.

* Dish racks were stored directly on the floor.

* A soiled cloth was observed stored over the clean flatware bin.

* There were undated and unlabeled foods in the walk in refrigerator and reach in refrigerator in the Memory Care dining room.

* Packaged foods were not dated when opened.

* There were expired food items in the walk in refrigerator.

The kitchen was reviewed with Staff 1 (Executive Director) and Staff 2 on 06/03/24. They acknowledged the findings.

-Splatter, spills, stains and debris- Clean handwashing sink twice a shift and as needed to cut down on debris.

Dining Director to over see and audit that it is done by 8/2/2024

-Hand washing sink will only be used for hand washing.

Can opener blade and casing to be cleaned after each use as well as checked every shift. Dining Director to over see and audit that it is continuing to be done by 8/2/2024

-Wire racks to be cleaned twice a week and as needed.

Staff to insure that racks are in good working condition. Dining Director responsible for audit and to make sure everything needing replaced is done so before 8/2/2024

-Open shelving in the kitchen will only contain dishware, that will be stored properly, staff to insure that racks are in good working order. Dining Director to audit daily. will be in compliance by 8/2/2024

-Deep cleaning of all walls and surfaces to be done once a month and as needed. Maintenance to clean and repair uncleanable surfaces and walls.

Deep clean of walk in freezer and refrigerator. And maintain a daily, weekly and monthly cleaning schedule. Dining Director to audit and maintain cleaning schedule by 8/2/2024

-Non slip grip to be replaced in freezer.

Floors to be cleaned daily. And deep cleaned once a month and as needed. Cleaning schedule and audit to be done daily by Dining Director and Executive Director

And will be in compliance by 8/2/2024

-All carts and equipment will be checked and cleaned daily. To be over seen by Dining Director. compliance by 8/2/2024

-Free standing air conditioner will be moved away from ice machine and cleaned weekly as needed. Will be monitored and tracked on cleaning schedule and be in compliance by 8/2/2024

-All damaged areas of floors, walls, shelving and cove bases to be repaired to be a cleanable surface. Maintenance Director to complete by 8/2/2024

-Plastic Cutting board to be replaced. Ordering new cutting board and will maintain and switch out when needed. Dining Director and Maintenance will replace and monitor. Compliance by 8/2/2024

-Wood rack on steam table to be replaced with a cleanable surface. Ordering and replacing wood cutting board with appropriate material. Compliance by 8/2/2024

-Dish racks to be stored in dish pit off of floor. Will be followed by Dining Director doing cleaning Audits and daily walk throughs. Compliance by 8/2/2024

-In-service with staff of where to place soiled rags, sign off sheet to be put in place to show that staff had the training. Daily audits and walk throughs done by Dining Director and Executive Director. Compliance by 8/2/2024

-Proper dating of opened items will be checked daily by kitchen staff and audited bu Dining Director. Compliance by 8/2/2024

-Food will be checked for expiration dates and thrown out before they are expired. Audited byb Dining Director. Compliance by 8/2/2024

Training on policy and procedures for kitchen operations to be provided by Executive Director. Executive Director and Dinning Director Will be responsible to see that the corrections are completed/ monitored no later then 8/2/2024 and on.

Based on observation, interview, and record review, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:

Refer to C 240.

-Splatter, spills, stains and debris- Clean handwashing sink twice a shift and as needed to cut down on debris.

Dining Director to over see and audit that it is done by 8/2/2024

-Hand washing sink will only be used for hand washing.

Can opener blade and casing to be cleaned after each use as well as checked every shift. Dining Director to over see and audit that it is continuing to be done by 8/2/2024

-Wire racks to be cleaned twice a week and as needed.

Staff to insure that racks are in good working condition. Dining Director responsible for audit and to make sure everything needing replaced is done so before 8/2/2024

-Open shelving in the kitchen will only contain dishware, that will be stored properly, staff to insure that racks are in good working order. Dining Director to audit daily. will be in compliance by 8/2/2024

-Deep cleaning of all walls and surfaces to be done once a month and as needed. Maintenance to clean and repair uncleanable surfaces and walls.

Deep clean of walk in freezer and refrigerator. And maintain a daily, weekly and monthly cleaning schedule. Dining Director to audit and maintain cleaning schedule by 8/2/2024

-Non slip grip to be replaced if freezer.

Floors to be cleaned daily. And deep cleaned once a month and as needed. Cleaning schedule and audit to be done daily by Dining Director and Executive Director

And will be in compliance by 8/2/2024

-All carts and equipment will be checked and cleaned daily. To be over seen by Dining Director. compliance by 8/2/2024

-Free standing air conditioner will be moved away from ice machine and cleaned weekly as needed. Will be monitored and tracked on cleaning schedule and be in compliance by 8/2/2024

-All damaged areas of floors, walls, shelving and cove bases to be repaired to be a cleanable surface. Maintenance Director to complete by 8/2/2024

Plastic Cutting board to be replaced. Ordering ne cutting board and will maintain and switch out when needed. Dining Director and Maintenance will replace and monitor. Compliance by 8/2/2024

-Wood rack on steam table to be replaced with a cleanable surface. Ordering and replacing wood cutting board with appropriate material. Compliance by 8/2/2024

-Dish racks to be stored in dish pit off of floor. Will be followed by Dining Director doing cleaning Audits and daily walk throughs. Compliance by 8/2/2024

-Inservice with staff of where to place soiled rags. Sign off sheet to be put in place to show staff received training. Daily audits and walk throughs done by Dining Director and Executive Director. Compliance by 8/2/2024

Proper dating of opened items will be checked daily by kitchen staff and audited bu Dining Director. Compliance by 8/2/2024

-Food will be checked for expiration dates and thrown out before they are expired. Audited by Dining Director. Compliance by 8/2/2024

Inservice on policy and procedures for kitchen operations to be provided by Executive Director with sign off sheets to show that staff received the training. Executive Director and Dinning Director Will be responsible to see that the corrections are completed/ monitored no later then 8/2/2024 and on