Aging and People with Disabilities
Safety, Oversight and Quality
Print Inspection: H6XE
Provider Information
5881 WOODSIDE DR SE
Salem, OR 97306
- Provider ID
- 5MA151
- Administrator
- BRANDY KHLYSTOV
- Phone
- (503) 316-0687
- brandy.khlystov@sincerisl.com
Inspection Details
- Date
- 1/18/2023
- Event ID
- H6XE
- Inspection type(s)
- State Licensure
- Deficiencies cited
- 3
Citation Details
C0000: Comment
- Visit Number
- 1
- Visit Date
- 1/18/2023
- Corrected Date
- N/A
- Details
-
The findings of the kitchen inspection, conducted on 01/18/23, 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.
- Visit Number
- 2
- Visit Date
- 4/11/2023
- Corrected Date
- N/A
- Details
-
The findings of the revisit to the kitchen inspection of 1/18/23, conducted 4/11/23, 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.
C0240: Resident Services Meals, Food Sanitation Rule
- Visit Number
- 1
- Visit Date
- 1/18/2023
- Corrected Date
- N/A
- Details
-
Based on observation and interview, it was determined the facility failed to ensure the kitchen was clean and in good repair, in accordance with the Food Sanitation Rules 333-150-0000. Findings include, but are not limited to:
On 01/18/23 at 10:30 am, the kitchen was observed to need cleaning and repair in the following areas:
* Dust/grease buildup on wall and piping above the stove;
* Vents above the toaster and steam table had buildup of dust/grease; and
* Lights in dry food storage area did not have covers on them.
The areas which required cleaning and repair were observed and discussed with Staff 1 (Food Service Director) on 01/18/23. The findings were acknowledged.
- Plan of Correction
-
C 240
* Dust / grease buildup on wall and piping above the stove was professionally cleaned within days of survey visit and will be on a quarterly cleaning schedule (and as needed).
* Dust / grease buildup on the vents above the toaster and steam table were taken down and cleaned. Will be on a cleaning rotation.
* Light covers in the store room were put on and will remain in place.
Food Service Director will add items to kitchen cleaning tool and will audit with Administrator to ensure plan of correction continues to be followed.
- Visit Number
- 2
- Visit Date
- 4/11/2023
- Corrected Date
- 1/25/2023
- Details
-
There are no detail notes for this visit.
Z0142: Administration Compliance
- Visit Number
- 1
- Visit Date
- 1/18/2023
- Corrected Date
- N/A
- Details
-
Based on observation and interview, 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.
- Plan of Correction
-
Z 142
* Please refer to C 240 above
- Visit Number
- 2
- Visit Date
- 4/11/2023
- Corrected Date
- 1/25/2023
- Details
-
There are no detail notes for this visit.