Print Inspection: KIT008405

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. This Rule is not met as evidenced by: Based on observation and interview, it was determined the licensee failed to ensure adequate administrative oversight of facility operations for food services. Findings include, but are not limited to: During the first revisit of the kitchen inspection of 11/07/25, conducted 01/15/26, administrative oversight to ensure adequate food services rendered in the facility was found to be ineffective based on failure to implement plan of correction and ensure adequate oversight to correct deficiencies. Refer to C 240.

Q1. What actions will be taken to correct the rule violation for each example/resident? A1. Actions taken to correct the violation include: -Pavilion management structure change to ensure cohesion in team member accountability and facility operations tied to compliance -Audit of the training, accountability, and compliance checklists to ensure they are adequate -Team member training Q2. How will the system be corrected so this violation will not happen again? A2. The system has been corrected through the following actions: -Senior Executive Director has provided additional training and set expectations for the Director of Food & Beverage who oversees the kitchen operations and team, and the Pavilion Administrator who oversees the facility operation and care team. -Community has hired a dedicated Dishwasher position to focus on daily cleaning tasks and compliance checks for kitchens -Team members have received information and training on the areas of violation. Team has been provided with task lists and performance expectations to be monitored. -Job Aids tied to MBK Senior Living policy and procedures are in place for all positions, for daily tasks. Q3. How often will the area needing correction be evaluated? A3. The areas needing correction will be evaluated in the following ways: -Daily by kitchen team members: cooks, dishwashers, Sous Chef -Five days per week by Food & Beverage Director and Pavilion Administrator -Weekly by Executive Director and/or Associate Executive Director Q4. Who will be responsible to see that the corrections are completed/monitored? A4. Food & Beverage Director and Pavilion Licensed Administrator

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals. This Rule is not met as evidenced by:

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 ensure kitchen practices and protocols were in accordance with the Food Sanitation Rules OARs 333-150-0000. Findings include, but are not limited to: On 12/11/25 at 10:40 am, the facility kitchen was observed to need cleaning in the following areas: * Microwave interior – splatters/food debris; * Walls above back splash in dishwashing area – significant build up of black matter ; * Floor underneath dishwasher – significant build up of black matter/debris; * Vents on drop ceiling area above steamer & steam jacketed kettle – build up of dust; * Food bin lids – food debris/spills; * Front of service line area storing serving platters – food debris/crumbs; * Three door freezer bottom shelf – food debris/spills; and * Three door freezer – uncovered meat patties/food debris on bottom shelf, vent ledge below doors drips/spills/debris. Other areas of concern included: * Colored cutting boards – finish worn/heavily scored; * Garbage cans throughout kitchen uncovered when not in use; and * Lack of facial hair restraints. Service Station areas of concerns: * Front of two door refrigerator – smears/spills; * Interior of microwave – splatters/food debris; * Ice cream tubs in freezer without lids; and * Warm server cabinet – bottom shelf with spills/drips/debris. The areas of concern were observed and discussed with Staff 1 (Food & Beverage Director) and discussed with Staff 2 (Assistant Executive Director) on 12/11/25. The findings were acknowledged.

What actions will be taken to correct the violation for each example/resident: 1. Actions taken to correct the violations are to complete a full cleaning of the areas noted in the SOD: -microwave, backsplash in dishwashing area, floor underneath dishwasher, vent in ceiling above steamer, front of service line, three door freezer bottom shelf and vent ledge before doors; -colored worn cutting boards with heavy scoring and ware are being replaced; -garbage can covers will be replaced and installed; -service station specific: cleaning of refrigerator, microwave, ice cream lids in place, cleaning server cabinet How will the system be corrected so this violation will not happen again? 2. The system will be corrected through an in-service training for dining employees, performing regular review of the cleaning schedule, and completion of scheduled compliance audits to ensure the areas cited are attended to according to MBK policy and Oregon Administrative Rules. How often will the area needing correction be evaluated? 3. The cited areas will be reviewed daily and documented to ensure compliance. Who will be responsible to see that these corrections are completed/monitored? 4. Kitchen employees including dishwashers, cooks, sous chef, Director of Food & Beverage, and Administrator.

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 ensure the kitchen was clean and in good repair 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 main facility kitchens and the memory care kitchenette on 01/16/26, from 11:00 am through 12:45 pm, revealed the following deficient practices: 1. Main Kitchen-Plaza 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: * Walls above back splash in dishwashing area – significant build-up of black matter ; * Floor underneath dishwasher – significant build-up of black matter/debris; * Vents on drop ceiling area above steamer & steam jacketed kettle – build-up of dust; * Food bin lids – food debris/spills; * Three door freezer bottom shelf – food debris/spills; and * Heavy accumulation of ice on interior of center door of three door freezer. b. Items in need of maintenance or repair: * Color coded cutting boards – finish worn/heavily scored/melted; and * Black rubber seal on center door of standing three-door freezer. c. Garbage cans throughout kitchen uncovered when not in use. d. Multiple cooks lacked facial hair restraints. 2. Plaza Kitchen Service Station: 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: * Front of two-door refrigerator – smears/spills; and * Warm server cabinet – bottom shelf with spills/drips/debris. b. Ice cream tubs in freezer did not have lids. 3. Pavilion Kitchen MCC: 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: *Sandwich station reach-in door rubber seal with heavy accumulation of black matter between folds of seal; and * Heavy build-up of black and brown matter in the ice machine interior. b. Uncovered food items in cooler. c. Food items with no open date in cooler. d. Warewashing machine racks were stored directly on floor. e. Food was being prepared without surface sanitation solution bucket set up or in use. 4. Pavilion Kitchen Service Station: 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: * Freezer door shelves and freezer bottom shelf. b. Surface sanitation bucket with no towel and multiple pieces of dirty silverware- sanitation bucket was being used as pre-soak for silverware. c. Multiple food items in refrigerator without open dates/prepared dates. d. Care staff were observed serving food without apron/protective barrier. e. Staff unable to state desired effective parts per million (PPM) range for surface sanitation solution; staff unaware of location of test strips. 5. Park 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: * Interior upper area of ice machine behind “harvest tray” with pink slime-like substance. b. Stand up cooler with multiple food items without an open date. c. Chest freezer with multiple ice cream tubs without lids properly secured. d. Cooking staff unable to state desired range for effective surface sanitation solution concentration PPM. e. Cooking staff unaware of how often surface sanitation solution bucket must be emptied and reset to ensure effective sanitation. At 12:20 pm surveyor met with Staff 1 (Associate Executive Director) and Staff 2 (Food and Beverage Director) to discuss findings. The findings were acknowledged by Staff 1 and Staff 2.

Q1. What actions will be taken to correct the rule violation for each example/resident? A1. Actions taken to correct the violation include deep cleaning of all areas noted in the SOD, ensuring all areas are on the daily cleaning checklist for all team members to monitor and guide tasks completion, repairing and replacing items on the SOD, training team members on actionable items: 1. Main Kitchen-Plaza a. Cleaning -Walls above backsplash in dishwashing area -Floors underneath dishwasher -Front of two-door refrigerator -Vents in ceiling above steam kettle - Food bin lids -Three door freezer cleaning -Three door freezer ice removal b. Repair/replace -Color coded cutting boards replaced -Black rubber seal on middle door of three-door freezer repaired or replaced c. Training and expectations -Garbage can lids are purchased and team trained to keep in place when not in use d. Training and expectations -Facial hair restraints are supplied and team is trained on proper usage per OAR 2. Plaza Kitchen Service a. Cleaning -Front of two-door refrigerator -Warm server cabinet shelf b. Repair/replace -Ice cream tubs have been purchased, and team members have received training on required use 3. Pavilion Kitchen MCC: a. Cleaning -Sandwich station reach-in door rubber seal -Ice machine interior b. Training -Cover food items c. Training -Date food items d. Training -Dish washing machine rack proper storage location e. Training -Proper sanitation practice for food prep area 4. Pavilion Kitchen Service Station: a. Cleaning -Freezer door shelves b. Training -Proper set up and use of sanitation bucket and separate silverware sanitation station c. Training -Date open food containers d. Training -Servers wear aprons during food service e. Training -Proper sanitation bucket solution prep and testing 5. Park Kitchen The Park kitchen was included on this Courtyard at Mount Tabor Pavilion 50R481 licence SOD but was not issued it's own SODs for the separate Park Kitchen for the Courtayard at Mount Tabor (assisted living) 70M239 and Courtyard at Mount Tabor Garden House (MCC) 5MA252 licenses. On Wednesday, January 27, 2026, Elena Bondareva-Bouchard visited the Park Kitchen for the reinspection #1. The inspector who visited on 1/15/2025 had not filed his inspection for the Park kitchen with ODHS. Elena spoke with Jeanie Bristol who advised that the 1/27/2026 inspection is the official revisit #1 and to disregard the 1/15/2026 inspection included in this SOD. The Park kitchen for licenses 70M239 and 5MA252 was placed into substantial complaince on 1/27/2026. Q2. How will the system be corrected so this violation will not happen again? A2. The system has been corrected through the following actions: -Senior Executive Director has provided additional training and set expectations for the Director of Food & Beverage who oversees the kitchen operations and team, and the Pavilion Administrator who oversees the facility operation and care team. -Community has hired a dedicated Dishwasher position to focus on daily cleaning tasks and compliance checks for kitchens -Team members have received information and training on the areas of violation. Team has been provided with task lists and performance expectations to be monitored. -Job Aids tied to MBK Senior Living policy and procedures are in place for all positions, for daily tasks. Q3. How often will the area needing correction be evaluated? A3. The areas needing correction will be evaluated in the following ways: -Daily by kitchen team members: cooks, dishwashers, Sous Chef -Five days per week by Food & Beverage Director and Pavilion Administrator -Weekly by Executive Director and/or Associate Executive Director Q4. Who will be responsible to see that the corrections are completed/monitored? A4. Food & Beverage Director and Pavilion Licensed Administrator

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 observation and interview, 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 C 240

Q1. What actions will be taken to correct the rule violation for each example/resident? A1. Actions taken to correct the violation include: -Pavilion management structure change to ensure cohesion in team member accountability and facility operations tied to compliance -Audit of the training, accountability, and compliance checklists to ensure they are adequate -Team member training Q2. How will the system be corrected so this violation will not happen again? A2. The system has been corrected through the following actions: -Senior Executive Director has provided additional training and set expectations for the Director of Food & Beverage who oversees the kitchen operations and team, and the Pavilion Administrator who oversees the facility operation and care team. -Community has hired a dedicated Dishwasher position to focus on daily cleaning tasks and compliance checks for kitchens -Team members have received information and training on the areas of violation. Team has been provided with task lists and performance expectations to be monitored. -Job Aids tied to MBK Senior Living policy and procedures are in place for all positions, for daily tasks. Q3. How often will the area needing correction be evaluated? A3. The areas needing correction will be evaluated in the following ways: -Daily by kitchen team members: cooks, dishwashers, Sous Chef -Five days per week by Food & Beverage Director and Pavilion Administrator -Weekly by Executive Director and/or Associate Executive Director Q4. Who will be responsible to see that the corrections are completed/monitored? A4. Food & Beverage Director and Pavilion Licensed Administrator

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 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 C240 above: What actions will be taken to correct the violation for each example/resident: 1. Actions taken to correct the violations are to complete a full cleaning of the areas noted in the SOD: -microwave, backsplash in dishwashing area, floor underneath dishwasher, vent in ceiling above steamer, front of service line, three door freezer bottom shelf and vent ledge before doors; -colored worn cutting boards with heavy scoring and ware are being replaced; -garbage can covers will be replaced and installed; -service station specific: cleaning of refrigerator, microwave, ice cream lids in place, cleaning server cabinet How will the system be corrected so this violation will not happen again? 2. The system will be corrected through an in-service training for dining employees, performing regular review of the cleaning schedule, and completion of scheduled compliance audits to ensure the areas cited are attended to according to MBK policy and Oregon Administrative Rules. How often will the area needing correction be evaluated? 3. The cited areas will be reviewed daily and documented to ensure compliance. Who will be responsible to see that these corrections are completed/monitored? 4. Kitchen employees including dishwashers, cooks, sous chef, Director of Food & Beverage, and Administrator.

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: During the first revisit to the kitchen inspection, conducted 01/15/26, administrative oversight to ensure adequate food sanitation practices in the facility kitchen was found to be ineffective based on multiple systems and practices which did not meet the Oregon Food Sanitation Rules. Findings include, but are not limited to: Refer to C240.

Refer to C240 Q1. What actions will be taken to correct the rule violation for each example/resident? A1. Actions taken to correct the violation include: -Pavilion management structure change to ensure cohesion in team member accountability and facility operations tied to compliance -Audit of the training, accountability, and compliance checklists to ensure they are adequate -Team member training Q2. How will the system be corrected so this violation will not happen again? A2. The system has been corrected through the following actions: -Senior Executive Director has provided additional training and set expectations for the Director of Food & Beverage who oversees the kitchen operations and team, and the Pavilion Administrator who oversees the facility operation and care team. -Community has hired a dedicated Dishwasher position to focus on daily cleaning tasks and compliance checks for kitchens -Team members have received information and training on the areas of violation. Team has been provided with task lists and performance expectations to be monitored. -Job Aids tied to MBK Senior Living policy and procedures are in place for all positions, for daily tasks. Q3. How often will the area needing correction be evaluated? A3. The areas needing correction will be evaluated in the following ways: -Daily by kitchen team members: cooks, dishwashers, Sous Chef -Five days per week by Food & Beverage Director and Pavilion Administrator -Weekly by Executive Director and/or Associate Executive Director Q4. Who will be responsible to see that the corrections are completed/monitored? A4. Food & Beverage Director and Pavilion Licensed Administrator

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: