Print Inspection: KIT007541

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, interview, and record review, it was determined the facility failed to maintain the kitchen in good repair and in a sanitary manner, and to ensure meals served were palatable and appropriate textures, in accordance with the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: Observation of the 5 cottage kitchens as well as the main kitchen meal preparation and food storage area on 10/22/25 at 09/30 am through 1:45 pm revealed the following deficiencies: 1) Main Kitchen 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: * Hood vents and sprinkler areas in industrial hood over stove; * Exterior of range; * Flooring between/behind range and oven; * Flooring in main kitchen entry way; * Flooring in dry storage; * Industrial mixer; * Stainless steal shelves storing spices and cutting boards; * Metal drawers storing cooking and serving utensils; * Exterior of trash can; * Wall behind range top/counter tops; * Walk in cooler fan cages; and * Janitor closet sink. b. Dry storage area with large garage door open with visible debris from outside on the floor. Food storage area shared with facility maintenance that has access to and opens door frequently causing potential access to pests. Multiple dry goods stored in area that are not in sealed containers that could lend to easy penetrable access to potential pests. c. Multiple potentially hazardous foods were found past seven days from preparation and should have been discarded. d. Multiple potentially hazardous foods observed without dates opened or prepared. e. Container of recyclables stored without lid in dishwashing area. f. Dishes in dishrack were overlapping and overloaded so that sanitizing agent could not effectively reach/touch all surfaces of equipment. 2) Clover Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Walls; * Fan cage/blades; * Blender base; * Window screen next to clean/sanitized dishes; * Exterior of trash can; * Wall behind range top/counter tops; * Toaster; and * Interior of reach in refrigerator. b. Flooring beside and underneath of dishwasher with damage/staining. Counter top with area of damage/bubble/discolored and not a smooth surface. c. Multiple items observed in the reach in refrigerator that did not have open dates. One item found past manufactures use by date and had signs of decay/potential bacterial growth. d. Multiple employee drink containers were found that were not of the approved style and were not covered, did not have a handle or a straw. e. Multiple meat and cheese items were stored in same drawer as fresh vegetables. f. One resident had a diet texture order of puree. During lunch service staff were observed to prepare a plate for this resident. The puree soup and puree sloppy joe had visible chunks and pieces/particles and was not smooth as required. Surveyors intervened prior to incorrectly processed food texture was served to the residents. Staff 2 (Dining Services Director) was also present and acknowledged the food items were not of the correct texture for puree. Staff continued processing the food until the correct texture was achieved. g. Clean and sanitized dishes were stored directly next to the sink where handwashing or washing of dirty dishes was done. No splash guard was in place to protect the clean/sanitized dishes from potential splash contamination. 3) Acorn Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Fan cage/blades; * Blender base; * Exterior of trash can; * Wall behind range top/counter tops; * Window screen next to clean/sanitized dishes; and * Interior of reach in refrigerator; b. Reach in refrigerator did not have a thermometer located to accurately monitor cold food temperatures. Facility had a log posted on the exterior of fridge that had multiple missing days. c. Multiple food items stored in reach in refrigerator were noted to be opened without open dates. d. Clean and sanitized dishes were stored directly next to the sink where handwashing or washing of dirty dishes was done. No splash guard was in place to protect the clean/sanitized dishes from potential splash contamination. 4) Sunflower Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Fan cage/blades; * Exterior of trash can; * Wall behind range top/counter tops; * Window screen next to clean/sanitized dishes; and * Interior of reach in refrigerator; b. Section of counter edge missing exposing porous wood. Multiple cabinets with shelving and/or interiors scratched/damaged. c. Multiple items found stored in reach in refrigerator without dates opened. d. Clean and sanitized dishes were stored directly next to the sink where handwashing or washing of dirty dishes was done. No splash guard was in place to protect the clean/sanitized dishes from potential splash contamination. e. Clean and sanitized cutting boards stored next to coffee maker sitting in free standing liquid potentially contaminating the sanitized equipment. 5) Blackberry Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Exterior of trash can; * Wall behind range top/counter tops; * Fan cage/blades; and * Window screen next to clean/sanitized dishes; b. Chemical dishwasher tested and did not register any parts per million (PPM) of sanitizer. Staff 2 primed the machine multiple times and still was not able to get test strips to register any ppm. Facility indicated they would sanitize resident dishes at another cottage until the dish machine could be serviced and operating correctly. c. Multiple items found stored in reach in refrigerator without open dates. A jar of homemade/canned salsa was noted in the fridge. Facilities must use/store only foods from approved sources. d. Clean and sanitized dishes were stored directly next to the sink where handwashing or washing of dirty dishes was done. No splash guard was in place to protect the clean/sanitized dishes from potential splash contamination. e. Multiple empty/used soda cans and bottles were noted stored on a shelf in the kitchenette area not in approved containers to prevent the attraction of pests. 6) Dandelion Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Window screen next to clean/sanitized dishes; * Reach in refrigerator base; * Interior of reach in freezer; * Exterior of trash can; * Wall behind range top/counter tops; * Flooring between dishwasher and cabinets: and * Fan blades and cage. b. Chemical dishwasher tested and did not register any parts per million (PPM) of sanitizer. Staff 2 primed the machine multiple times and still was not able to get test strips to register any ppm. Facility indicated they would sanitize resident dishes at another cottage until the dish machine could be serviced and operating correctly. c. Multiple items found stored in reach in refrigerator without open dates. A jar of homemade/canned pears was noted in the fridge. Facilities must use/store only foods from approved sources. d. Clean and sanitized dishes were stored directly next to the sink where handwashing or washing of dirty dishes was done. No splash guard was in place to protect the clean/sanitized dishes from potential splash contamination. e. Multiple packages of food items were found stored in reach in refrigerator and freezer that were open and exposed to potential contamination. f. A staff drink container was found stored in the freezer next to resident foods. g. At 11:40 am, the reach in refrigerator thermometer was found at 54 degrees. Food item inside was tested and found at 48 degrees. Refrigerator temperature monitoring log for October was reviewed and documented 14 times where the temperature of the fridge was greater than 41 degrees. Staff 2 acknowledged the refrigerator temperature was too high and discarded the food item that temped greater than 41 degrees. Staff 2 verified the facility would check the temperature of all potentially hazardous food items in that fridge and discard what was not at the correct cold food storage temperature. Staff 2 stated that they had not been made aware of any temperature concerns with that refrigerator. Staff 2 toured all areas with Surveyors and acknowledged the findings. At 1:15 pm the surveyors reviewed the areas in need of cleaning, repair and practices with Staff 1 (Executive Director) who acknowledged the areas in need of correction.

C0240 1. The following corrections were made/or are being made for the identified findings: MAIN KITCHEN a.All areas identified as needing cleaning have been cleaned b. Dry Storage will be re-arranged so that products that can be penetrated by pests are not stored in that area or are contained in a pest proof container c.Food past the 7 days expiration were immediately discarded. d. Foods not dated were discarded e. Recycleable were discarded and a container with a lid will be obtainedf for future use f. Dishes were rewashed after identification of overlapping. CLOVER COTTAGE a. all areas identified as needing cleaning were/are being deep cleaned. b. damaged flooring is scheduled to be repaired c. The items found in the refrigerator without dates opened were thrown away. d. cleaned/sanitized dishes were moved 12" to the right away from the sink, and messaging went out to adopt this practise/location immediately; to all team leads e. cutting boards will be relocated away form the coffee pot. BLACKBERRY COTTAGE a. all areas identified as dirty or needing cleaning were/are being cleaned b. dishwasher sanitizer is being adjusted so that it will dispense as designed and dishes were done elsewhere until the fix was completed. c. items found undated in the refrigerator were discarded if not dated. Resident homemade canned salsa was discarded and families will be notifed about home canned goods not being allowed unless consumed on the spot by their resident d. cleaned/sanitized dishes were moved 12" to the right away from the sink, and messaging went out to adopt this location/practise immediately to all team leads. e. recyceable items were removed and will not be stored in the kitchen unless an approved container is present. DANDELIION COTTAGE a. all areas identified as needing cleaned were cleaned b. dishwasher sanitizer is being adjusted so that it will dispense as designed and dishes were done elsewhere until the fix was completed. c. items not labeled/dated were discarded and the home made canned item was disposed of. Resident families were notified about home made canned goods not being allowed unless consumed on the spot. d. cleaned/sanitized dishes were moved 12" to the right away from the sink and messaging went out to the team leads to adopt this location from now on. e. Food found not label and dated was discarded in both the refrigerator and freezer f. the staff drink container was discarded from the freezer. g. Staff notified Maintenance that the refrigerator was not maintaining temp for either repair or replacement 2. Systems Corrected to Prevent Future Violations: to prevent future violations, the community will a. inservice all staff involved in keeping the kitchens clean and in good repair (11/11/2025 Inservice) reviewing the cleaning and repair issues that were identified. b. inservice food prep staff on the importance of food safety in meal preparation outlining each item found during survey and explaining what systems are in place to prevent unsanitary conditions. Included will be our expectations on compliance during each meal prepared. 3. To ensure ongoing compliance with said procedures, the community will perform sytems audits of the food preparation areas to validate the findings are no longer occuring. These audits will be on a cadence directed by the facility Quality Assurance Committee however, for the initial plan of correction the facility will perform: a. weekly audits of all areas, for one month starting immediately b. at least 2x a month for the remainder of the quarter. If no compliance is substantially achieved at the end of the quarter, and at the direction of the QA committee these audits will be performed at least monthly for the remainder of the 12 months. Additionally the DSD will continue to inservice newly hired staff during orientation to the expectations of food safety and sanitation. 4. A letter will be emailed to families about resident personal food storage and the rule about storing home canned goods for any period of time. The Director of Food Services and the Administrator are primarily responsible for the monitoring and effectivness of this plan of correction. 5. Facility alledges the facility will be in compliance by December 21, 2025.

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 good repair and in a sanitary manner, in accordance with the Food Sanitation Rules, OAR 333-150-000. This is a repeat citation. Findings include, but are not limited to: Observation of the five cottage kitchens, as well as the main kitchen meal preparation and food storage area, on 01/02/26 at 10:45 am through 12:45 pm revealed the following deficiencies: 1) Main Kitchen 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: * Wall behind stove with dust; * Ceiling above stove and prep table with dust; and * Walk-in cooler fan cages. b. Multiple potentially hazardous foods were found past seven days from preparation date and should have been discarded. c. Multiple items observed in the walk-in cooler that did not have open dates noted. 2) Clover Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Window screen next to clean/sanitized dishes; * Exterior of trash can; and * Wall behind range top/counter tops. b. Flooring beside and underneath dishwasher with damage/staining. Area on countertop with section of exposed wood, yielding an unsmooth surface. c. Multiple items observed in the reach-in refrigerator that did not have open dates noted. d. Multiple potentially hazardous foods were found past seven days from open/prepared date and should have been discarded. e. An employee drink container was found that was not covered and did not have a handle or a straw. f. A bowl of yogurt for a resident was stored uncovered and was not protected from potential contamination. 3) Acorn Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; and * Window screen next to clean/sanitized dishes. b. Multiple food items stored in the reach-in refrigerator were noted to be opened or prepared without open/prepared dates noted. 4) Sunflower Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Fan cage/blades; and * Window screen. b. Multiple items found stored in the reach-in refrigerator were without dates opened and/or prepared noted. Potentially hazardous food items were observed to be past seven days from opened/prepared date and should have been discarded. 5) Blackberry Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Wall behind range top/counter tops; * Window screen; and * Side and in between cabinet next to dishwasher. b. Potentially hazardous food items were found stored in the reach-in refrigerator without open/prepared dates. 6) Dandelion Cottage 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: * Interior/exterior of cupboards/cabinets/drawers storing clean dishes and/or food; * Window screen next to clean/sanitized dishes; * Reach-in refrigerator base; * Wall behind range top/countertops; * Side of cabinet and floor in between cabinet and refrigerator; and * Flooring between dishwasher and cabinet. b. Multiple items were found stored in the reach-in refrigerator without open dates. Staff 2 (Dining Services Director) toured all areas with surveyor and acknowledged the findings. At 12:30 pm the surveyor reviewed the areas in need of cleaning and repair and deficient practices with Staff 1 (Executive Director), who acknowledged the areas still in need of correction.

C0240 OAR 411-054-0030 Resident Services and Meals Food Sanitation Rules Upon identification of the finding the facility : MAIN KITCHEN a. cleaned identified areas of spills, splatters, loose food and trash debris, dirt, dust, black matter, and grease that was visible on the wall behind the stove, ceiling above the stove and prep table, walk in cooler fan cages b.disposed of food that was older than 7 days or unlabeled c. disposed of food not dated in the walk in CLOVER COTTAGE: a.cleaned splatters and crumbs from drawers/cabinets and cupboards; cleaned the kitchen window screen; wiped down the wall behind the trash can and range top counter tops. b. the flooring underneath was replaced/repaired c. items undated or unlabed were tossed out d. items in the refrigerator undated were thrown out e. the employee drink was discarded as uncovered f. the uncovered bowl of residents' yogurt was discarded.

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 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation. This Rule is not met as evidenced by: Based on interview, observation, and record review, it was determined the facility failed to ensure their kitchen survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to: Refer to C240.

ACORN COTTAGE a. spills, splatters, crumbs from cupboards/cabinets and drawers was cleaned and the window screen was cleaned. b. items in the refrigerator without labels or undated were thrown away. SUNFLOWER COTTAGE a. splatters, dust, and spills were cleaned from the interior/exteriors of cupboards/drawers, fan blades, and the windown screen. b. unlabeled or undated items or outdated food items were thrown away when found in the refrigerator. BLACKBERRY a. identified splatters, dust, and spills were cleaned from the cupboards/drawers, the wall behind the range, counter tops, the window screen and the wall near the dishwasher between cabinets. b. unlabeled outdated or not dated food items identified were disposed of from the refrigerator.

OAR 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation. 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 observations and interviews, 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.

Z0142 See above elements 1-5 for the facilities plan of correction and alledged date of compliance 12/21/251

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. This is a repeat citation. Findings include, but are not limited to: Refer to C240.

DANDELION COTTAGE a. spills, splatters, dust, crumbs and other dirts were cleaned from the interior of cupboards and drawers, the reach in refrigerator base, the window screen; the wall behind the range top and countertops; the sides and floor between cabinet and refrigerator, and the flooring between dishwasher and cabinet. b. items found in the refrigerator without open dates were thrown out. 3. TO INSURE FUTURE COMPLIANCE the facility will: a. institute the kitchen cleanliness audit schedule that will review compliance on a calendered cadence: Weekly for six weeks until findings are rare if ever; Monthly for an additional six weeks unless findings reappear in which case it will revert to a cadence decided upon by the QA Committee and Dietary Manager. 4. PERSON RESPONSIBLE TO MAINTAIN COMPLIANCE The Dietary Supervisor and the Administrator are primarily responsible to insure the corrections are implemented and stay intact. 5. Facility alleges it will be in compliance by Feb 15, 2026. C0455 Inspections and Investigations See C0240 above Plan of Correction Z0142 Administrative Compliance - see POC

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: