Print Inspection: KIT010775

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 OAR 333-150-000. Findings include, but are not limited to: On 04/14/26, between 10:45 am and 1:00 pm, the facility kitchen was observed to need corrections in the following areas: 1. Cleaning and/or Repair: * Low temperature dish machine – wash and rinse temperatures not registering on gauge, and pH was below minimum requirements; * Cutting boards – stained, heavily scored, non-cleanable; * Floor by ice machine – exposed cement, non-cleanable; * Ice scoop container – debris inside by scoops; and * Ice machine – brown, white, red residue. During an observation on 04/14/26 at approximately 11:30 am, Staff 1 (PIC/Dining Services Manager) demonstrated the dish machine gauge did not register wash and rinse temperatures and pH was below minimum requirements. Staff planned to use the three-compartment manual ware washing until the repair was completed. During an observation on 04/14/26 at approximately 11:00 am, the surveyor observed the inside of the ice machine to have brown, white, and red residue. The surveyor requested that the ice be discarded and the machine not be used until it was thoroughly cleaned. 2. Food Storage/Sanitation: * Multiple meat items in fridge – without dates; * Multiple foods and food thickener were expired, and were discarded at the surveyor’s request; * Silverware – left uncovered, unattended in the dining room; * Janitor closet/chemicals – exposed to clean dishes; and * Cross contamination – caregivers passing food without a barrier covering potentially contaminated clothing. At approximately 11:15 am, the surveyor found leftover alfredo sauce in a ten-inch-deep storage container in the fridge. Staff 1 (PIC/Dining Services Manager) reported that she cooled it on the counter and was unable to verbalize the proper cooling method. Surveyor provided proper cooling methods and staff discarded the food. 3. Modified Diets: During an observation and interview on 04/14/26 at approximately 12:15 pm, Staff 1 (PIC/Dining Services Manager) explained that the diet/texture orders were posted. Surveyor noted that the last update was 02/19/26. Staff 1 reported that there have been residents admitted and diet/texture changes since then. Staff 1 was unable to report or deliver accurate IDDSI SB6 textures as ordered. The areas of concern were discussed with Staff 1 (PIC/Dining Services Manager) and Staff 2 (Executive Director) at approximately 1:00 pm on 04/14/26. Staff acknowledged the findings.

1. Cleaning and/or Repair: * Low temperature dish machine – wash and rinse temperatures not registering on gauge, and pH was below minimum requirements; *Gauge has been professionally repaired. Temps taken daily and documented. Documentation submitted monthly to ED. Dining Service Manager and/or Lead Cook for the daily to take temps. Dining Service Manager to submit temp log to ED. Dining Service Manager and ED to audit weekly. * Cutting boards – stained, heavily scored, non-cleanable; New cutting boards ordered. Condition of cutting boards to be on monthly check off list to ensure cleanable service and good condition. Dining Service Manager to check off monthly. * Floor by ice machine – exposed cement, non-cleanable; Vinyl sheeting to be placed on exposed cement. Maintenance Director to install. Maintenance Director and Dining Service Manager responsible for flooring and on monthly check off list to ensure no cracks, chips, and flooring remains cleanable surface. * Ice scoop container – debris inside by scoops; Ice scoop container to be cleaned daily. Dining Service Manager and/or Lead Cook responsible for daily clean at the end of shift. On daily cleaning check off list. and * Ice machine – brown, white, red residue. Ice Machine to be cleaned monthly. Maintenance Director to clean and on monthly cleaning check off list. Check off list at the end of the month is given to the ED. Audit monthly performed by ED and/or Dining Service Manager. 2. Food Storage/Sanitation: * Multiple meat items in fridge – without dates; Laminated posters posted on the wall with food labeling requirements. Staff meeting held with expectation of labeling. Labeling listed on daily check off list. Audit weekly with Dining Service Manager * Multiple foods and food thickener were expired, and were discarded at the surveyor’s request; Food discarded immediately. Labeling procedures in place. Rotating shelved foods. Monthly expiration audit in place with check list. Dining Service Manager responsible for checklist and audit. * Silverware – left uncovered, unattended in the dining room; Once silverware is completed being rolled- silverware moved back to the kitchen. Care Partners/Dining Service Manager/Lead Cook * Janitor closet/chemicals – exposed to clean dishes; Janitor closet door is kept closed with sign posted to have door remain closed. Care Partners/Dining Service Manager/Lead Cook and * Cross contamination – caregivers passing food without a barrier covering potentially contaminated clothing. Aprons are hung inside kitchen. Postings stating requirements for aprons. Dining Service Manager/Care Partners/Lead Cook responsible. 3. Modified Diets: During an observation and interview on 04/14/26 at approximately 12:15 pm, Staff 1 (PIC/Dining Services Manager) explained that the diet/texture orders were posted. Surveyor noted that the last update was 02/19/26. Staff 1 reported that there have been residents admitted and diet/texture changes since then. Staff 1 was unable to report or deliver accurate IDDSI SB6 textures as ordered. Update orders requested by PCP. Dining Service Manager to receive training on mechanical soft and diet orders. ED/HSD responsible for updating orders. *Each of these areas will be monitored by the Dining Service Manager and the ED. Dining Service Manager and ED will audit checklists weekly and monthly to ensure that all items are being cleaned, remain in good repair, and documentation is accurate. Staff will be initaling daily, weekly, biweekly or monthly when completing tasks. Dining Service Manager and ED will hold staff accountable for cleaning and intialing the checklists.

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: