Print Inspection: KIT006372

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). This Rule is not met as evidenced by: Based on observation and interview, it was determined the facility failed to maintain the kitchen in a sanitary manner and ensure food was prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). Findings include, but are not limited to: On 08/21/25, from 10:25 am to 3:33 pm, interviews with staff and observations of the facility kitchen, memory care kitchenette, food storage areas, food preparation, and food service were conducted. The following was identified: a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter, and grease was visible on or underneath the following: * Walls throughout the kitchen, dry food storage, and ware wash area; * Flooring under and around large equipment and food preparation areas; * Flooring in the dry storage room; * Flooring in the walk-in refrigerator and freezer; * Large vent above food preparation area; * Ceiling and light fixtures near the large vent above food preparation area; * Walk-in refrigerator and freezer doors and handles; * Walk-in refrigerator vent/fan; * Light fixture and fire sprinkler on the ceiling in the walk-in refrigerator; * Interior and exterior of the oven; * Surface of the grill; * Interior and exterior of the deep fryer; * Interior and exterior of the microwave in the kitchen; * Dry storage door; * Metal storage racks located in the dry storage area; * Exterior of the rolling canisters located in the dry storage room; * Cabinet located in the corner, to the right of the air conditioning unit; * Open shelving in the food preparation area and interior of cabinet below the prep sink; * Industrial mixer; * Air conditioning unit; * Fire alarm on the wall under the air conditioning unit; * The interior of the dish washer in the memory care kitchenette; * Interior and exterior of toaster stored in the memory care kitchenette; and * Interior of cabinets under the sink and steam table in the memory care kitchenette. b. The following areas were noted in need of repair: * There was a hole in the ceiling, above the air conditioning unit, with missing, broken, and peeling material, that was located above food preparation and serving areas; * The walk-in refrigerator door had large area that was rust colored; * The ceiling in the walk-in refrigerator had water dripping from the center; * Staff reported the ovens were not used because they would smoke and the fire alarms would sound; * The grease trap (large black box under three-compartment sink) had a missing part and staff reported there was a leaking part where a large pan was observed under the leaking area; * Ware wash area lacked a seal around the dish pit; * Food warmer/cart for the MCC had a bungee cord wrapped around it and staff reported it was “broken”; * Walk-in refrigerator door had missing hardware; * The walk-in freezer door frame had significant ice build up; * Multiple blue bread pans had broken, chipped, cracked, and missing material; * Walls throughout the kitchen, ware wash area, and dry storage room had missing material, holes, scratches, and chipped material; * The doors to the dry storage room, back exit, and entry door had chipped, cracked, peeling, and missing material; * Tiles at the entry door to the kitchen were broken and cracked; * Two dry food canister lids had cracks and broken areas that exposed food product; * There was a rectangular hole in the wall under the air conditioning unit; * A cabinet located to the corner to the right of the air conditioning unit, had broken, chipped, cracked, and missing material; * Walk-in refrigerator ceiling light fixture had multiple cracks; * The glass window located on the bottom right corner of the dining service directors office had a hole and glass was broken; * The steamer was noted to leak and had a saturated towel in front of the steamer throughout the survey; * Staff reported the grill was not used because of excess smoke when used; * The steam table had five black plastic inserts with holes melted on the corners; * A metal table with the industrial can opener had several holes on the surface; * The MCC kitchenette counter, secured to the wall, had missing and worn material on the right and left corners; * The MCC kitchenette had a sliding drawer on the bottom left side that did not close and a drawer on the top left side that lacked a drawer face; * The MCC kitchenette had cabinets with bent hardware and one cabinet that lacked hardware and the cabinet handle was not securely attached; * The interior of the cabinets located under the sink had broken and missing material; * An electrical outlet plate to the right of the steam table was cracked, broken, and missing material; and * The raised counter in front of the steam table in the memory care kitchenette was missing laminate and had exposed material. c. The temperature of prepared food was not consistently taken prior to serving. d. The temperature of a hot dog was requested prior to being served. Staff 4 (Cook) reported the temperature to be 111 degrees Fahrenheit, which did not meet the required minimum temperature. On 08/21/25 at 2:30 pm, Staff 2 (Executive Director) and Staff 3 (Dining Service Director) completed a walk-through of the kitchen with this surveyor and reviewed the above areas noted. At 2:58 pm, Staff 1 (Memory Care Administrator), Staff 2, and Staff 3 completed a walk-through of the MCC kitchenette with this surveyor and the above was reviewed. The need to ensure the kitchen was maintained in a sanitary manner and food was prepared and served in accordance with Food Sanitation Rules was reviewed with Staff 1, Staff 2, and Staff 3 on 08/21/25 at 3:19 pm. They acknowledged the findings.

1. a. Kitchen walls, flooring under and around large equipment & food prep areas, dry storage & refrigerator/freezer cleaned 9/5/25. Ceiling vent, ceiling/light fixtures in food prep areas, fridge/freezer door handles & vent/fan, light fixture & fire sprinkler cleaned 9/5/25. Interior/exterior of oven, microwave & deep fryer, grill surface cleaned 9/5/25. Dry storage door, metal racks, exterior of rolling canisters cleaned 9/5/25. Cabinet by A/C, open shelving in food prep area & interior of cabinet below sink, industrial mixer, A/C & fire alarm beneath cleaned 9/5/25. Memory Care; Interior of dishwasher was cleaned 8/26/25. Toaster replaced; cleaned daily after use. Interior of cabinets under sink/steam table cleaned 8/26/25. b. Hole in ceiling above A/C, rust on fridge door, ceiling in fridge water drip from ceiling to be repaired. Grease trap missing cap replaced. Wash ara to be sealed around dish pit. Food warmer cart door to be repaired. Fridge door missing hardware to be replaced. Ice build-up on freezer door to be checked & removed daily, call vendor. Blue bread pans in bad condition removed. Walls with holes, scratches, chips to be repaired. Doors to dry storage and back entry door chips & cracks to be repaired. Cracked tile at entry door to be replaced. Two dry storage canister lids to be replaced with new lids. Hole in wall under A/C to be repaired & sealed. Cabinet to right of A/C to be repaired/replaced. Fridge ceiling light fixture to be replaced (date). DSD glass window crack to be repaired. Steamer leak to be checked and seal repaired if needed. Grill cleaned. Steam table rubber well guards to be replaced. Metal table with holes by can opener to be sealed. Memory Care; kitchenette counter on wall side to be epoxied or capped where missing or worn laminate. Sliding left bottom drawer fixed, face of top left drawer replaced. Missing cabinet hardware replaced and bent hardware fixed and securely attached. Interior of cabinet under sink where material is broken/missing to be covered with stainless steel plate. Electrical outlet plate to be replaced at steam table area. Missing laminate on raised steam table counter to be epoxied &/or capped. Food temperatures are being taken, recorded prior to service daily to ensure proper serving temperatures. 2. Updated kitchen cleaning schedules posted & initialed off daily & weekly and staff inserviced. 3. Cleaning schedules and Food temperatures will be reviewed daily and weekly. Needed repairs reported to Maintenance as they occur. 4. Robert Kutschke, DSD and Steve Matthew, ED, Mayra Palominos, MCD or Designee will oversee & monitor the processes.

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). This Rule is not met as evidenced by:

OAR 411-054-0050(1-5) Infection Prevention & Control (Amended 03/18/2022)(1) Facilities must establish and maintain infection prevention and control protocols to provide a safe, sanitary and comfortable environment. This includes protocols to prevent the development and transmission of communicable diseases.(2) Each facility must designate an individual to be the facility ' s "Infection Control Specialist" responsible for carrying out the infection prevention and control protocols and serving as the primary point of contact for the Department regarding disease outbreaks. The Infection Control Specialist must:(a) Be qualified by education, training and experience or certification; and(b) Complete specialized training in infection prevention and control protocols within three months of being designated under this paragraph, unless the designee has received the specialized training within the 24-month period prior to the time of the designation. The Department will describe trainings that will be acceptable to meet the specialized training requirement in rule, by January 1, 2022.(3) Each facility must establish infection prevention and control protocols and have an Infection Control Specialist, trained as required in this rule, by July 1, 2022.(4) Facilities must comply with masking requirements as prescribed in OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control the spread of COVID-19.(5) Facilities must comply with vaccination requirements for COVID-19 as prescribed in OAR 333-019-1010.Stat. Auth.: ORS 410.070, 443.004, 443.012, 443.450Stats. Implemented: ORS 443.004, 443.400-443.455, 443.991 This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to have a designated Infection Control Specialist who completed the specialized training in infection prevention and control protocols. Findings include, but are not limited to: On 08/21/25 at 10:36 am, documentation of the designated Infection Control Specialist and Infection Control Specialist training was requested. At 2:28 pm, Staff 1 (Executive Director) reported the designated Infection Control Specialist had not completed the specialized training in infection prevention and control protocols. The need to ensure the facility had a designated Infection Control Specialist who completed the specialized training in infection prevention and control protocols was reviewed with Staff 1 and Staff 2 (Dining Service Director) on 08/21/25 at 3:19 pm. They acknowledged the findings.

1. Our Wellness Director or Associate Wellness Director will complete the 4-hour OregonCarePartners Infection Control Specialist course and be our community designated Infection Control Specialist. 2. Wellness Director or Associate Wellness Director will maintain the Infection Control Specialist title every 243 months to hold the designation ongoing. 3. Every two years the Wellness Director or Associate wellness Director will retake the Infection Control Specialist training course to remain current. 4. Steve Matthews, Executive Director

OAR 411-054-0050(1-5) Infection Prevention & Control (Amended 03/18/2022)(1) Facilities must establish and maintain infection prevention and control protocols to provide a safe, sanitary and comfortable environment. This includes protocols to prevent the development and transmission of communicable diseases.(2) Each facility must designate an individual to be the facility ' s "Infection Control Specialist" responsible for carrying out the infection prevention and control protocols and serving as the primary point of contact for the Department regarding disease outbreaks. The Infection Control Specialist must:(a) Be qualified by education, training and experience or certification; and(b) Complete specialized training in infection prevention and control protocols within three months of being designated under this paragraph, unless the designee has received the specialized training within the 24-month period prior to the time of the designation. The Department will describe trainings that will be acceptable to meet the specialized training requirement in rule, by January 1, 2022.(3) Each facility must establish infection prevention and control protocols and have an Infection Control Specialist, trained as required in this rule, by July 1, 2022.(4) Facilities must comply with masking requirements as prescribed in OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control the spread of COVID-19.(5) Facilities must comply with vaccination requirements for COVID-19 as prescribed in OAR 333-019-1010.Stat. Auth.: ORS 410.070, 443.004, 443.012, 443.450Stats. Implemented: ORS 443.004, 443.400-443.455, 443.991 This Rule is not met as evidenced by:

OAR 411-057-0140(2) Administration Compliance (2) The licensee of a memory care community must comply with both the licensing rules for the facility and Chapter 411, Division 57. This Rule is not met as evidenced by: 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 C240.

Refer to 240.

OAR 411-057-0140(2) Administration Compliance (2) The licensee of a memory care community must comply with both the licensing rules for the facility and Chapter 411, Division 57. This Rule is not met as evidenced by: