Print Inspection: RL012222

OAR 411-054-0030 (1)(c-d) Resident Services: Activities (c) A daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs, and creates opportunities for active participation in the community at large; (d) Equipment, supplies and space to meet individual and group activity needs; This Rule is not met as evidenced by: Based on observation and interview, it was determined the facility failed to provide a daily program of social and recreational activities that were based upon individual and group interests, physical, mental, and psychosocial needs, and created opportunities for active participation in the community at large. Findings include, but are not limited to: On 06/02/26 at 11:10 am, Staff 2 (Memory Care Director) informed the surveyor the facility did not have a calendar of scheduled activities for the month of June 2026 as had been requested by the surveyor. She confirmed the facility did not currently have an activities staff, and acknowledged the facility had to develop and implement a daily schedule of activities for the residents. Observations during the survey from 06/01/26 to 06/03/26 showed a lack of scheduled and unscheduled activities provided for residents living in the memory care community. The need to ensure the facility provided a daily program of social and recreational activities for the residents was reviewed with Staff 1 (ED), Staff 2, and Staff 3 (RN, Health Services Coordinator) on 06/03/26 at 10:05 am. The findings were acknowledged.

0242 OAR 411-054-0030 (1)(c-d) Resident Services: Activities *Activity calendar has been completed and posted with structured activities for residents to participate in. An LEC has been identified and will assume responsibility for activity programming upon hire and training. During vacancy, the Memory Care Director will be resposible for instructing and coordinating meaningful activities. Every month, the Memory Care Director will assess the activity calendar as well as resident participation.

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, interview, and record review, 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 C242.

Z0142 OAR 411-057-0140(2) Administration Compliance Juniper House Memory Care has implemented the corrective actions identified under tag C242. The Memory Care Director will review activity programming and resident participation monthly to ensure resident enrichment and ongoing compliance with Memory Care licensing requirements.

OAR 411-057-0155(1-6) Staff Training Requirements (1) A memory care community must ensure staff who provide support to residents with dementia have a basic understanding and fundamental knowledge of the residents' emotional and unique health care needs prior to providing services to residents. The training requirements for staff who work in memory care communities are described in the following sections. (2) ALL STAFF TRAINING REQUIREMENTS. All staff who work in memory care communities licensed as residential care facilities or assisted living facilities must complete the following: (a) Orientation as required in OAR 411-054-0070(3) before performing any job duties. (b) Pre-service dementia care training as required before independently providing personal care or other services. The dementia care training must address these topics: (A) Education on the dementia disease process, including the progression of the disease, memory loss and psychiatric and behavioral symptoms. (B) Techniques for understanding, communicating and responding to distressful behavioral symptoms; including but not limited to, reducing the use of antipsychotic medications for non-standard uses when responding to distressful behavioral symptoms. (C) Strategies for addressing social needs of persons with dementia and engaging them with meaningful activities; (D) Information concerning specific aspects of dementia care and ensuring safety of residents with dementia including, but not limited to, how to: (i) Identify and address pain; (ii) Provide food and fluid; (iii) Prevent wandering and elopement; (iv) Use a person-centered approach. (c) Additional pre-service training topics that must be completed before independently providing personal care to residents: (A) Environmental factors that are important to resident ' s well-being (e.g. noise, staff interactions, lighting, room temperature, etc.); (B) Family support and the role the family may have in the care of the resident; (C) How to recognize behaviors that indicate a change in the resident ' s condition and report behaviors that require on-going assessment. (3) DIRECT CARE STAFF TRAINING REQUIREMENTS. Direct care staff must be directly supervised by a qualified staff person until they have successfully demonstrated satisfactory performance in any task assigned in the provision of individualized resident services. In addition to training required for all staff as described in paragraph (2): (a) Before independently providing personal care or other services to residents, direct care staff must complete training on: (A) How to provide personal care to a resident with dementia, including an orientation to the resident and the resident ' s service plan, as required in OAR 411-054-0070(4). (B) The use of supportive devices with restraining qualities in memory care communities. (b) Within 30 days after hire, direct care staff must complete training as outlined in OAR 411-054-0070(5). (c) Direct care staff who work in memory care communities licensed as residential care facilities or assisted living facilities must complete a total of 16 hours of in-service training annually. The six hours of annual dementia care training required pursuant to OAR 411-054-0070(6) may be included in the 16 hours of in-service training. Annual in-service hours required of each staff are due by the anniversary date of that person ' s hire. All completed trainings must be documented by the facility. (4) NURSING FACILITY STAFF. Staff who work in memory care communities licensed as nursing facilities must complete the following: (a) Orientation as outlined in OAR 411-086-0310, 42 CFR ? 483.95 (F 943). (b) Pre-service dementia care training as outlined in paragraphs (2)(b) and (c) and paragraph (3)(a) of this section. (c) A total of 16 hours of annual in-service training must be completed by direct care staff only. Four of the 16 hours must be dementia care training and may be included in the 16 hours of in-service training. Annual in-service hours required of each staff are due by the anniversary date of that person ' s hire. All completed trainings must be documented by the facility. (5) Persons providing or overseeing the training of staff must have experience and knowledge in the care of individuals with dementia. (6) The memory care community must have a method for determining and documenting each staff person ' s competency of training in accordance with the licensing rules. All training must be documented and available to the Department upon request. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure 2 of 3 newly hired staff (#s 8 and 9) completed all required pre-service orientation prior to performing any job duties and 3 of 3 newly hired staff (#s 7, 8, and 9) completed all required pre-service dementia training and demonstrated competency in all assigned job duties within 30 days of hire. Findings include, but are not limited to: Staff training records were reviewed on 06/02/26 at 12:50 om with Staff 2 (Memory Care Director). The following was identified: Staff 7 (CG/MT) was hired 09/02/25, Staff 8 (CG/MT) was hired 10/15/25, and Staff 9 (CG/MT) was hired 11/12/25. a. There was no documented evidence of completion of the following pre-service orientation: * Staff 7 lacked fire safety and emergency procedures; and * Staff 8 lacked fire safety and emergency procedures and infectious disease prevention. b. There was no documented evidence Staff 7, 8, and 9 completed the required pre-service dementia topics: * Environmental factors that are important to a resident's well-being; and * Family support and the role family may have in the care of the resident. c. There was no documented evidence Staff 7, Staff 8, and Staff 9 demonstrated competency in one or more of the following assigned job duties within 30 days of hire: * Role of service plans in providing individualized care; * Providing assistance with ADLs; * Changes associated with normal aging; * Identification, documentation and reporting changes of condition; and * Conditions that require assessment, treatment, observation and reporting. The need to ensure staff completed all required training within the specified time frames was discussed with Staff 1 (ED), Staff 2, and Staff 3 (RN, Health Services Coordinator) on 06/03/26 at 10:05 am. The findings were acknowledged.

Z0155 OAR 411-057-0155(1-6) Staff Training Requirements Training records were reviewed and any missing training documentation and competency validations have been completed. A training tracking and audit process has been implemented to ensure all state-required trainings are completed and documented within the required 30-day timeframe for all newly hired staff. The Memory Care Director will review training records monthly and during the onboarding process to ensure ongoing compliance.

OAR 411-057-0160(2)(c)(A)(B) Nutrition and Hydration (c) A daily meal program for nutrition and hydration must be provided based upon the resident ' s preferences and needs available throughout each resident ' s waking hours. The individualized nutritional plan for each resident must be documented in the resident ' s service or care plan. In addition, the memory care community must provide: (A) Visual contrast between plates, eating utensils, and the table to maximize the independence of each resident; and (B) Adaptive eating utensils for those residents who have been evaluated as needing them to maintain their eating skills. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to ensure an individualized nutrition and hydration plan was developed and documented in the resident's service plan for 2 of 2 residents (#s 1 and 2) whose records were reviewed. Findings include, but are not limited to: Resident's 1 and 2's current service plans were reviewed during survey. Each of the service plans lacked information and staff instructions related to individualized nutrition and hydration status and needs. The need to develop individualized service plans addressing residents' nutrition and hydration needs was discussed with Staff 1 (ED), Staff 2 (Memory Care Director), and Staff 3 (RN, Health Services Coordinator) on 06/03/26 at 10:05 am. The findings were acknowledged.

Z0163 OAR 411-057 0160(2)(c)(A)(B) Nutrition and Hydration Resident service plans were reviewed and updated to include individualized nutrition and hydration needs, preferences, and staff instructions. A service plan audit process has been implemented to ensure nutrition and hydration information is included and updated as resident needs change. The Memory Care Director and Health Services Coordinator will review service plans during quarterly service reviews and upon significant changes in condition to ensure nutrition and hydration needs remain current and accurately documented

OAR 411-057-0160(2d) Activities (d) Meaningful activities that promote or help sustain the physical and emotional well-being of residents. The activities must be person centered and available during residents ' waking hours. (A) Each resident must be evaluated for activities according to the licensing rules of the facility. In addition, the evaluation must address the following: (i) Past and current interests; (ii) Current abilities and skills; (iii) Emotional and social needs and patterns; (iv) Physical abilities and limitations; (v) Adaptations necessary for the resident to participate; and (vi) Identification of activities for behavioral interventions. (B) An individualized activity plan must be developed for each resident based on their activity evaluation. The plan must reflect the resident ' s activity preferences and needs. (C) A selection of daily structured and non-structured activities must be provided and included on the resident ' s activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (i) Occupation or chore related tasks; (ii) Scheduled and planned events (e.g. entertainment, outings); (iii) Spontaneous activities for enjoyment or those that may help diffuse a behavior; (iv) One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); (v) Spiritual, creative, and intellectual activities; (vi) Sensory stimulation activities; (vii) Physical activities that enhance or maintain a resident ' s ability to ambulate or move; and (viii) Outdoor activities. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to ensure each resident was evaluated for activities addressing all required elements, develop an individualized activity plan based on their activity evaluation, and provide a selection of daily structured and unstructured activities for 2 of 2 sampled residents (#s 1 and 2) whose evaluations and service plans were reviewed. Findings include, but are not limited to: Observations of Residents 1 and 2 were conducted from 06/01/26 to 06/03/26. Staff were not observed to provide a selection of daily structured and unstructured activities for Residents 1 and 2. The most recent evaluations and current service plans were reviewed for Residents 1 and 2. The following was identified: a. There was no documented evidence an activity evaluation had been completed that addressed all the following: * Past and current interests; * Current abilities and skills; * Emotional and social needs and patterns; * Physical abilities and limitations; * Adaptations necessary for the resident to participate; and * Identification of activities for behavioral interventions. b. There was no documented evidence an individualized activity plan was developed for each resident. During an interview on 06/02/26 at 11:15 am, Staff 2 (Memory Care Director) confirmed the facility’s most recent resident activity/interest evaluation form had not been completed for either Resident 1 or Resident 2. The need to ensure activity evaluations were completed, individualized activity plans were developed, and a selection of daily structured and unstructured activities were provided for residents was discussed with Staff 1 (ED), Staff 2, and Staff 3 (RN, Health Services Coordinator) on 06/03/26 at 10:05 am. The findings were acknowledged.

Z0164 OAR 411-057-0160(2d) Activities Resident activity evaluations were completed and individualized activity plans were developed for affected residents. Activity preferences, abilities, interests, behavioral interventions, and participation needs were incorporated into resident service plans. An activity audit process has been implemented to ensure activity evaluations and individualized activity plans are completed, current, and reflective of everyone’s needs and preferences. The Memory Care Director and Life Enrichment Coordinator will review activity evaluations, activity plans, and resident participation during quarterly service reviews and upon significant changes of condition to ensure ongoing compliance and person-centered activity programming.