Print Inspection: FZ24

The findings of the relicensure survey, conducted 06/11/24 through 06/13/24, are documented in this report. The survey was conducted to determine compliance with the OARs 411 Division 54 for Residential care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities, and OARs 411 Division 004 Home and Community Based Services Regulations.

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.

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

CG:caregiver

cm:centimeter

ED:Executive Director

F:Fahrenheit

HH:Home Health

LPN:Licensed Practical Nurse

MA:          Medication Aide

MAR:Medication Administration

Record

MCC:Memory Care Community

mg:milligram

ml:milliliter

MT:Medication Technician

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

QI:     quality improvement

RCC:       Resident Care Coordinator

RN:     Registered Nurse

TAR:     Treatment Administration

Record

tid:           three times a day

The findings of the first re-visit to the re-licensure survey of 06/13/24, conducted 11/05/24 through 11/06/24, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities and OARs 411 Division 004 Home and Community Based Services Regulations.

3. Resident 3 was admitted to the facility in 06/2020, with diagnoses including Alzheimer's disease, hypertension, and osteoporosis.

Resident 3's progress notes, dated 03/11/24 through 06/11/24, and incident reports revealed the following:

a. On 05/10/24, the resident was found by staff in the secured outside courtyard area, seated on ground next to a potted plant. S/he had sustained skin tears to right knee and right foot.

b. On 05/14/24, Resident 3 experienced a fall in the common area, which resulted in a laceration to the back of his/her head. Staff reportedly heard the fall and rushed to the area. The resident was found lying on floor, conscious but bleeding from head.

The incident reports indicated that in both of the falls the resident was unable to verbalize or explain what happened, and both events were unwitnessed. Both reports documented "Neglect was ruled out, as care plan was being followed correctly by care staff."

In an interview on 06/12/24, Staff 1 (Reflections Administrator) stated an understanding of the need to document investigations of all falls, to effectively rule out abuse or neglect.

On 06/12/24, the need for all falls which could not be explained by the resident, when the event was unwitnessed, to be promptly reported to the local SPD office was discussed with Staff 1 (Reflections Administrator). She acknowledged the findings.

The facility was asked to report the two falls to the local SPD office. Confirmation of the reports was provided on 06/19/24, following survey exit.

Based on observation, interview, and record review, it was determined the facility failed to ensure injuries of unknown cause were reported to the local SPD office or the local AAA as suspected abuse, unless an immediate facility investigation reasonably concluded and documented that the injury was not the result of abuse, and promptly investigate reports of abuse and suspected abuse related to falls, verbal altercations and injuries of unknown cause, for 3 of 3 sampled residents (#s 1, 2 and 3) whose incidents were reviewed. Findings include, but are not limited to:

1. Resident 1 was admitted to the memory care facility in 11/2022 with diagnoses including dementia.

The resident's service plan, dated 05/07/24, incident reports, progress notes from 03/05/24 through 06/11/24, observations of the resident, and interviews with care staff revealed the following:

* 04/09/24: "Alert for skin tear to L [left] hand. Hospice bath aide reported two small dime size skin tears. This [MT] cleansed wound and applied steri strips."

There was no evidence the injury of unknown cause had been investigated by the facility or reported to the local SPD office as required.

In an interview with Staff 1 (Reflections Administrator) on 06/13/24 at 2:12 pm, she reviewed the resident's record and stated the incident had not been investigated by the facility, or reported.

The need to ensure all injuries of unknown cause were reported to the local SPD office, or the local AAA, as suspected abuse, unless an immediate facility investigation reasonably concluded and documented that the physical injury was not the result of abuse was discussed with Staff 1 on 06/13/24. The findings were  acknowledged and incidents reported.

2. Resident 2 moved into the facility in 12/2022 with diagnoses including dementia.

The resident's clinical record, including progress notes dated 03/11/24 through 06/11/24, incident reports, short term observation notes (STO's) for the same time period were reviewed, and interviews were conducted.

The facility failed to immediately report abuse or suspected abuse to the local SPD office and promptly investigate all reports of abuse and suspected abuse for the following incident:

05/05/24 - Observation notes indicated Resident 2 was "agitated with [another resident] and making threatening/concerning comments to the point [the other resident] was scared."

The need to ensure all incidents of abuse were immediately reported to the local SPD office was discussed with Staff 1 (Reflections Administrator) on 06/17/24. She acknowledged the findings.

On 06/17/24, survey requested the facility report the incident to the local SPD office, verification was received on 06/18/24.

OAR 411-054-0028 (1-3)

Reporting & Investigation Abuse - Other Action

1. The immediate actions taken to correct this rule violation are as follows:

a. Resident #1  Incident report completed for L hand skin tears. Reported to APS on 7/2/2024.

b. Resident #2 had incident report completed for threatening/concerning comments to the point the other resident was scared. Reported to APS on 6/17/24

c.i.Resident #3 unwitnessed fall that sustained skin tears to right knee and right foot. Reported to APS on 6/19/24 following survey exit. ii. 5/14/24 unwitnessed fall which resulted in laceration to back of head. Reported to APS 6/19/24 following exit interview.

2. To ensure the system will be corrected so this violation will not happen again:

a. All facility staff will complete training on 'Elder Abuse Prevention, Investigation and Reporting provided by Oregon Care Partner by 8/1/24.

b. All staff will be provided additional training on the following topics: Incident report requirements, investigating incident reports, how to appropriately rule out abuse and neglect, implementing new interventions via STO's, ensuring previous interventions and applicable service planning care were being followed to showcase rule out of abuse and neglect secondary to as evidenced by when to report and when to contact local APS by 8/1/2024.

c. The system will be corrected so the violation will not happen again by ensuring all incidents are investigted timely. If abuse or neglect can not be ruled out, or for injuries of unknown cause, community will follow Abuse reporting requirement to APS. Incident reports are reviewed with daily stand up meetings. The community will include incident reporting and investigating abuse and neglect as part of the continuous quality improvement plan. Community will verify the correct process for self reporting to APS has taken place for all reportable incidents.

3. This area will be reviewed on a daily basis with incident review in stand up, monthly and on quarterly basis.

4. The facility Administrator or designee will be responsible for ensuring the system is corrected and monitored.     

Based on observation, interview and record review, it was determined the facility failed to ensure service plans were reflective of residents' needs and provided clear direction to staff regarding the delivery of services for 3 of 3 sampled residents (#s 1, 2, and 3) whose service plans were reviewed. Findings include, but are not limited to:

1. Resident 3 was admitted to the facility in 06/2020 with diagnoses of Alzheimer's disease, hypertension, and osteoporosis.

Review of Resident 3's service plan, dated 05/22/24,  interviews with staff, and observations of the resident revealed the service plan was not reflective or did not provide clear direction to staff in the following areas:

* Fall interventions;

* Skin care/monitoring;

* Nutrition and hydration; and

* Individual and group activities.

On 06/13/24 the need to ensure service plans were reflective of current care needs and provided clear direction to staff was discussed with Staff 1 (Reflections Administrator). She acknowledged the findings.

3. Resident 1 moved into the facility in 11/2022 with diagnoses including dementia.  

The resident's current service plan dated 05/07/24 and short term observation notes (STOs) from 03/14/24 to 04/27/24 were reviewed, observations of the resident were made, and interviews with the resident's family and staff were conducted.

The service plan was not reflective of the resident's current needs and preferences or did not provide clear direction to staff in the following areas:

* Eating status including level of assistance, food and fluid preferences;

* Customary routines including eating and sleeping routines;

* Interests, hobbies, social and leisure activities and preferences;

* How and when s/he expressed pain;

* Decision making ability;

* Use of assistive device including geri chair;

* Environmental factors that may contribute to behaviors;

* Assistance level for ADLs including need for two care staff; and

* Transfer status including need for two care staff.

The need to ensure the service plan reflected the resident's current needs and provided clear instructions to staff regarding the delivery of services was discussed with Staff 1 (Reflections Administrator) on 06/13/24. She acknowledged the findings.

2. Resident 2 moved into the facility in 12/2022 with diagnoses including dementia.  

Staff interviews were conducted during the survey and the current service plan dated 03/05/24 was reviewed.

Resident 2's service plan was not reflective of the resident's current needs and lacked clear instructions to staff in the following areas:

* Eating status including dental status and food and fluid preferences;

* Customary routines including eating and sleeping routines;

* Interests, hobbies, social, leisure preferences and activities including, activities to redirect behaviors ;

* Ability to understand others and to be understood;

* Decision making ability;

* Personality and how s/he coped with change and challenging situations;

* Environmental factors that may contribute to behaviors, including wandering and exit seeking; and

* Instructions for emergency evacuation.

The need to ensure the service plan reflected the resident's current needs and provided clear instructions to staff regarding the delivery of services was discussed with Staff 1 (Reflections Administrator), Staff 3 (Wellness Nurse) and Staff 4 (Wellness Director) on 06/12/24. They acknowledged the findings.

OAR 411-054-0036 (1-4) Service Plan: General

1. Actions taken to correct the rule violation are as follows:

a. Resident #3 service plan has been updated to be reflective of the resident's needs and preferences, and clear instructions to staff in the following areas:

* fall interventions

* Skin monitoring/care monitoring

* Nutritional and hydrations

* Individual and group activities

b. Resident #2 service plan has been updated to be reflective of resident's needs and preferences, and clear instructions to staff in the following areas:

*Eating status including dental status and food and fluid preferences

*Customary routines including eating and sleeping routines

*Interests, hobbies, social, leisure preferences and activities including activities to redirect behaviors,

*Ability to understand others and to be understood

*Decision making ability

*Personality and how she coped with change and challenging situations

*Environmental factors that may contribute to behaviors, including wandering and exit seeking, and instructions for emergency evacuation.

c. Resident #1 service plan has been updated to be reflective of resident's needs and preferences and clear instructions to staff in the following areas:

* Eating status including level of assistance, food and fluid preference

*Customary routines including eating and sleeping routines

*Interest hobbies, social and leisure activities and preferences

*How and when she expressed pain

*Decision making ability

*Use of assistive device including geri chair

*Environmental factors that may contribute to behaviors

*Assistance level for ADLs including for two care staff

*Transfer status including need for two care staff

2. The system will be corrected so this violation does not happen again by ensuring that the service plan is created to reflect the Resident's current status prior to move in, 30 days, every 90 days thereafter or with any significant change of condition per company policy and Oregon State Rule.

All updates to service plan should be initialed and dated. Leadership to provide observations to ensure service plan are being followed.

All resident service plans should be reviewed and updated to reflect any changes or personalization via "STO". Clinical staff, care staff, Administrator and resident participate with this process to ensure accuracy, as well as family upon approval/request by the resident. All updates to the service plan are placed in the 24hr.book for all staff to review and sign off on.

3. The area needing correction will be evaluated quarterly. Changes to service plans will be reviewed daily in stand up meeting to ensure accuracy and appropriateness, and make changes as needed.

4. Facility Administrator, Nursing, or designess will be responsible for completion and monitoring.

3. Resident 3 was admitted to the facility in 06/2020, with diagnoses including Alzheimer's Disease, hypertension, and osteoporosis

Review of Resident 3's progress notes, dated 03/11/24 through 06/11/24, service plan, dated 05/22/24, and incident reports revealed the following:

a. A progress note dated 05/12/24 stated "Res skin tear on [his/her] right knee and right foot top area are improving or healing".

An incident report dated 05/10/24 indicated these injuries were the result of a fall. There was no documented evidence the skin tears were monitored with progress noted at least weekly through resolution.

In an interview on 06/12/24, Staff 3 (Wellness Nurse) stated there was no other documentation of skin monitoring, besides the progress notes.

b. Resident 3's records revealed the resident had experienced four falls in the last 90 days. The service plan included the following fall interventions:

* Check environment and lighting;

* Remind resident to use call light;

* Perform safety checks, PRN; and

* Bed adaptations, PRN.

There was no documented evidence new interventions were implemented or that the existing interventions were evaluated for effectiveness, following repeated falls.

On 06/12/24 the need to ensure short-term changes of condition were monitored at least weekly to resolution, and current interventions were evaluated for effectiveness was discussed with Staff 1 (Reflections Administrator) and Staff 3. They acknowledged the findings.

2. Resident 1 was admitted to the facility in 11/2022 with diagnoses including dementia.

The resident's 05/07/24 service plan, 03/05/24 through 06/11/24 progress notes, short term observation notes (STOs) from 03/14/24 to 04/27/24 were reviewed and interviews were conducted. Resident 1 experienced the following short-term changes of condition:

* 05/03/24 "Has pain and discomfort when being moved in bed";

* 05/04/24 " ...only c/o [complained of] discomfort when staff having to place new brief near peri area";

* 05/04/24 "resident has some discomfort when being moved around physically";

* 05/05/24 "resident was in pain during changing brief in bed"; and

* 05/05/24 "resident continue to complain pain when moving/turning/repositioning".

The facility failed to evaluate the resident's pain to determine if service-planned interventions were implemented, were effective or if new interventions were needed, and failed to communicate determined actions/interventions to staff on each shift. Additionally, there was no documented evidence the facility consistently monitored and documented on the progress of the resident's condition at least weekly until resolved.

The need to ensure the facility had a system to evaluate, determine, and document what actions or interventions were needed, communicate the interventions to staff, and monitor progress of the conditions to resolution was reviewed with Staff 1 (Reflections Administrator) on 06/13/24. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to evaluate, determine and document what actions or interventions were needed, communicate the interventions to staff, and monitor progress of the conditions to resolution for 3 of 3 sampled residents (#'s 1, 2 and 3) who experienced changes of condition. Findings include, but are not limited to:

1. Resident 2 moved into the facility in 12/2022 with diagnoses including dementia.

The resident's clinical record, including progress notes, dated 03/11/24 through 06/11/24, short term observation notes (STO's), and the current service plan dated 03/05/24 were reviewed, and interviews were conducted.

There was no documented evidence the facility evaluated, determined what resident-specific actions or interventions were needed, and communicated the determined actions or interventions to staff,  and/or documented weekly progress through resolution for the following short-term change of condition:

05/05/24 - Agitated with another resident and was making threatening/concerning comments to the point the other resident was scared.

The need to ensure resident-specific actions or interventions for short-term changes of condition were determined, documented, and communicated to staff on each shift and the changes of condition were monitored, at least weekly, through resolution was discussed with Staff 1 (Reflections Administrator), Staff 3 (Wellness Nurse) and Staff 4 (Wellness Director) on 06/12/24. They acknowledged the findings.

OAR 411-054-0040 (1-2) Change of Condition and Monitoring

1. Actions taken to correct this rule violation area as follows:

Resident #1's service plan was reviewed and updated by facility RN to include ways to redirect resident if he becomes agitated. Resident has not had any further altercations.

Resident #2's service plan was reviewed and updated to include repositioning and proper chair support to help with pain management. We also continue to collaborate her care and pain management with hospice. Resident has chronic pain.

Resident #3's skin tears have resolved. Facility RN reviewed service plan and updated with additional fall interventions. Additionally a medication reconciliation as been requested from hospice to ensure we are using the lowest dose of any and all psychotropic meds.

2. To ensure the system will be corrected so this violation doesn't happen again, a 24 hour communication system will be in place that includes:

A. Shift to shift communication log

B. Alert Charting/ Short term observations

C. Significant Change of condition log

D. Weekly Skin monitoring

1) Staff will alert short term observation/communication system for any resident identified to have an acute change of condition such as skin events, increased confusion, return from hospital, new medication or a fall to name a few.

2) Staff will be trained on what to report to Nurse and/or MD per the short term observation/STO. The STO will have specific instructions so staff understand the intervention and what and when to report.

3) Staff will monitor resident until condition improves and they are back at their baseline or the need for a higher level of care.

4) System will be reviewed daily, monthly and quarterly to ensure compliance is corrected and monitored.

Based on interview and record review, it was determined the facility failed to ensure PRN medication used to treat a resident's behavior had written, resident-specific parameters and non-drug interventions for staff to attempt prior to administering a PRN psychoactive medication, for 3 of 3 sampled residents (#s 1, 2, and 3) who were prescribed PRN psychotropic medications. Findings include, but are not limited to:

1. Resident 3 was admitted to the facility in 06/2020 with diagnoses of Alzheimer's disease, hypertension, and osteoporosis.

Review of Resident 3's MAR, dated 05/01/24 through 06/11/24 revealed the following:

The resident was prescribed the following two PRN psychotropic medications:

* Diazepam 2 mg - Take one tablet by mouth as needed for anxiety;

* Lorazepam 2 mg/mL - Take .25 mL by mouth every four hours for nausea and/or agitation and/or anxiety.

The MAR lacked instructions for staff regarding the sequential order of use for these PRN medications, and lacked documentation of non-pharmacological interventions to attempt prior to PRN administration.

In an interview on 06/12/24, Staff 20 (MT) showed the surveyor the MAR on the computer used for medication pass. There was no documentation of the PRN parameters or non-drug interventions in Resident 3's electronic MAR. Staff 20 stated these are not seen or used in the facility's current medication system.

On 06/13/24, the need to include resident-specific parameters for use of PRN psychotropic medications on the MAR, and to document non-pharmacological interventions to be attempted prior to administration was discussed with Staff 1 (Reflections Administrator). She acknowledged the findings.

3. Resident 1 moved into the facility in 11/2022 with diagnoses including dementia.

Review of the resident's 05/01/24 through 06/11/24 MARs and current physician orders identified the following:

* The resident was prescribed haloperidol 2 mg/ml to be administered 0.25 ml by mouth every two hours as needed for agitation, delirium, nausea and/or vomiting;

* The resident was prescribed lorazepam 0.5 mg to be administered one tablet by mouth every four hours as needed for anxiety, insomnia, or terminal delirium; and

* The MAR lacked written resident specific non-pharmacological interventions to attempt prior to administration of the PRN medication.

The 05/01/24 through 06/11/24 MAR identified unlicensed staff did not administer the medications to the resident.

The need to ensure there were resident specific non-drug interventions for staff to attempt prior to the administration of psychotropic medications was reviewed with Staff 1 (Reflections Administrator) on 06/13/24. They acknowledged the findings.

2. Resident 2 moved into the facility in 12/2022 with diagnoses including dementia.

Review of the resident's 05/01/24 through 06/11/24 MARs and current physician orders identified the following:

* The resident was prescribed olanzapine 5 mg tablet to be administered a 1/2 tablet (2.5 mg) by mouth every six hours as needed for agitation/hallucinations; and

* The medication was administered six times without documented non-pharmacological interventions attempted with ineffective results prior to administering the medication.

The need to ensure unlicensed staff attempted and documented non-pharmacological interventions with ineffective results prior to administering a PRN psychotropic was discussed with Staff 1 (Reflections Administrator), Staff 3 (Wellness Nurse) and Staff 4 Wellness Director) on 06/12/24. They acknowledged the findings.

OAR 411-054-0055

Systems: Psychotropic Medication

1. Immediate actions taken to correct the rule violation is as follows:

a. Resident #3 had a comprehensive audit of the MAR. The MAR has been updated to the sequential order of use for the PRN medications and non pharmacological interventions to attempt prior to PRN administration

b. Resident #1 Any new order for PRN psychoactive medication to treat mood or behavior issues will be reviewed by the Licensed Nurse through the triple check process. The Licensed Nurse will ensure appropriate resident indicators for use are in place as well as non-pharmaceutical interventions staff should offer prior to using. All active PRN psychoactive medications will be reviewed prior to quarterly psychian order sent for signature as well as with scheduled PRN medication audits.

Based on interview and record review, it was determined the facility failed to provide fire safety instruction to residents, at least annually, in accordance with the Oregon Fire Code (OFC). Findings include, but are not limited to:

Review of facility records on 06/12/24 identified the following deficiencies:

There was no documented evidence that annual training on fire safety was provided to residents.

On 06/13/24, the need to provide and document fire safety instruction to residents, at least annually, in accordance with the OFC was discussed with Staff 1 (Reflections Administrator) and Staff 6 (Maintenance Director). They acknowledged the findings.

OAR-411-054-0090 (5) Fire and life safety training for residents

1. Immediate action taken to correct the rule violation:

* All residents who can comprehend have been talked to and have signed the annual fire life and safety training.Resident that can't comprehend have been notated on there indiviual form. All forms are in a binder in the maintenance office.

2. The annual training has been added to the shared calendar with ED and Maintenance for every year in June so that all that received the annual this june will on time every upcoming year and every new resdeint will also receive this training every June.

3 This will be monitored yearly in june.

4. The ED will be responsible to verify that all current residents have receieved their updated trainings and then to also verify that every june this training has been completed with every resident.   

Based on observation and interview, it was determined the facility failed to ensure handrails were installed at one or both sides of resident-use corridors. Findings include, but are not limited to:

During the tour of the MCC building's interior, conducted on 06/11/24, it was observed a section of resident-use corridor lacked a handrail on either side to assist residents with safety.

The need to ensure handrails were accessible to residents along corridors was discussed with Staff 1 (Reflections Administrator) on 07/02/24. She acknowledged the findings.

OAR 411-054-0200(4) (A-b) General building interior

1.Action taken: We had a carpenter come in to take measurements for creating new hand rails on 7/16/24.

2.System is being corrected by having new hand rails made and installed by deadline.

3.The corrections will be evaluated weekly to ensure handrails are functioning properly

4.Admin and Maintenance director will be responsible to see that corrections are completed and monitored.

Based on observation and interview, it was determined the facility failed to keep all interior materials and surfaces clean and in good repair. Findings include, but are not limited to:

The facility's interior was toured on 06/11/24 at 9:54 am. The following issues were identified:

* Gouges on the walls in multiple areas including the dining room, ceiling columns, and wall beneath the windows by the Administrator's office;

* Window sill in the dining room;

* Baseboards in the dining room were pulling away from the wall;

* Baseboards and door frame around the Administrator's office;

* Wall vent beneath the handrail and across from Room 109 had dust buildup;

* Multiple gouges in resident apartment doors including but not limited to Rooms 113,116, 120,122, 129, 133 and the housekeeping door;

* Multiple handrails throughout the facility had chipped paint and/or exposed wood;

* The residential style washing machine in the small laundry room located on the unit had black matter buildup and a strong odor in the air;

* Ceiling vent in the small laundry room located on the unit had a buildup of dust; and

* The commercial dryer in the central laundry area was inoperable.

The need to ensure the facility was clean and in good repair was discussed and the environment was toured with Staff 1 (Reflections Administrator) and Staff 6 (Maintenance Director) on 06/13/24. They acknowledged the findings.

OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors

1. a.Gouges on the walls in multiple areas including dining room, ceiling columns, and wall beneath the window by administrators office, windown sill in the dining room will  be sanded, textured, and painted.

b. Baseboards in dining room has been nailed into place and will be painted.

c. Wall vents beneath the handrail and across from room 109 has been cleaned the day of survey.

d. Gouges in multiple residents apartment doors will be sanded and painted.

e. Chipped paint and/or exposed wood on the handrails will be sanded and painted.

f. ceiling vent in small laundry room with build up dust has been cleaned the day of survey.

g. dryer that was inoperable will be replaced with new dryer.

2. i. Maintenece Director, Admin, Ed and other team members will be monitoring daily with walk throughs.

3. Daily

4. Maintence Director, Admin,and Ed will be responsible to see that the corrections are completed/monitored.

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 231, C 422, and C 513.

OAR 411-057-0140(2) Administration Compliance

Refer to C 231, C 422 and C 513

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 C 260, C 270, C 280, and C 330.

OAR 411-057-0160(2b) Compliance with Rules Health Care

Refer to C 260, C 270, C 280 and C 330.

Based on interview and record review, it was determined the facility failed to ensure a daily meal program based on resident's preferences and needs that was individualized and documented in the resident's service plan for 3 of 3 sampled residents (#s 1, 2 and 3) whose service plans were reviewed. Findings include, but are not limited to:

Resident 1, 2 and 3's current service plans were reviewed during survey. Each service plan lacked information and/or staff instructions related to the individualized nutrition and hydration status, preferences, and needs of the resident.  

The need to develop a daily meal program based on resident's preferences and needs that was individualized and documented in the resident's service plan was discussed with Staff 1 (Reflections Administrator) on 06/13/24. They acknowledged the findings.

OAR 411- 057- 0160(2)(c)(A)(B) Nutritional and Hydration

Refer to C 260