Print Inspection: RL014686

OAR 411-054-0034 (1-6) Resident Move-in & Evaluation: Res Evaluation Temporary rule language in effect until 02/05/2027 (1) INITIAL SCREENING AND MOVE-IN. (a) The facility must determine whether a potential resident meets the facility's admission requirements. (b) Before the resident moving in, the facility must conduct an initial screening to determine the prospective resident's service needs and preferences. The screening must determine the ability of the facility to meet the potential resident's needs and preferences, while considering the needs of the other residents and the facility's overall service capability. (c) Each resident record must, before move-in and when updated, include the following information: (A) Legal name for billing purposes. (B) To promote person-centered care, any variance from legal records, as indicated by the resident, regarding: (i) Name. (ii) Pronouns. (iii) Gender identity. (C) Prior living arrangements; (D) Emergency contacts; (E) Service plan involvement - resident, family, and social supports; (F) Financial and other legal relationships, if applicable, including, but not limited to: (i) Advance directives; (ii) Guardianship; (iii) Conservatorship; and (iv) Power of attorney. (G) Primary language; (H) Community connections; and (I) Health and social service providers. (2) RESIDENT EVALUATION - GENERAL. The resident evaluation identifies the resident's preferences, strengths, and relationships, as well as activities that are meaningful to the individual. The evaluation describes the resident's physical health status, mental status, and the environmental factors that help the individual function at their optimal level. The evaluation is the foundation that a facility uses to develop the resident's service plan. The evaluation information may be collected using tools and protocols established by the facility, but must contain the elements stated in this rule. (a) Resident evaluations must be: (A) Performed before the resident moves into the facility, with updates and changes as appropriate within the first 30 days; and (B) Performed at least quarterly, to correspond with the quarterly service plan updates. (C) Reviewed and any updates must be documented each time a resident has a significant change in condition. (D) Done in person and the facility must gather data that is relevant to the needs and current condition of the resident. (E) Documented, dated, and indicate who was involved in the evaluation process. (b) 24 months of past evaluations must be kept in the resident's files in an accessible, on-site location. (c) The facility administrator is responsible for assuring only trained and experienced staff perform resident evaluations. (3) EVALUATION REQUIREMENTS AT MOVE-IN. (a) The resident evaluation must be completed before the resident moves into the facility. This evaluation provides baseline information of the resident's physical and mental condition at move-in. (b) If there is an urgent need and the evaluation is not completed before move-in, the facility must document the reasons and complete the evaluation within eight hours of move-in. (c) The initial evaluation must contain the elements specified in section (5) of this rule and address sufficient information to develop an initial service plan to meet the resident's needs. (d) The initial evaluation must be updated and modified as needed during the 30 days following the resident's move into the facility. (e) After the initial 30 day move-in period, the initial evaluation must be retained in the resident's file for 24 months. Future evaluations must be separate and distinct from the initial evaluation. (4) QUARTERLY EVALUATION REQUIREMENTS. (a) Resident evaluations must be performed quarterly after the resident moves into the facility. (b) The quarterly evaluation is the basis of the resident's quarterly service plan. (c) The most recent quarterly evaluation, with documented change of condition updates, must be in the resident's current record and available to staff. (d) If the evaluation is revised and updated at the quarterly review, changes must be dated and initialed and prior historical information must be maintained. (5) The resident evaluation must address the following elements: (a) For service planning purposes, if indicated by the resident, (A) Name. (B) Pronouns. (C) Gender identity. (b) Resident routines and preferences including: (A) Customary routines, such as those related to sleeping, eating, and bathing; (B) Interests, hobbies, and social and leisure activities; (C) Spiritual and cultural preferences and traditions; and (D) Additional elements as listed in 411-054-0027(2). (c) Physical health status including: (A) List of current diagnoses; (B) List of medications and PRN use; (C) Visits to health practitioners, emergency room, hospital, or nursing facility in the past year; and (D) Vital signs if indicated by diagnoses, health problems, or medications. (d) Mental health issues including: (A) Presence of depression, thought disorders, or behavioral or mood problems; (B) History of treatment; and (C) Effective non-drug interventions. (e) Cognition, including: (A) Memory; (B) Orientation; (C) Confusion; and (D) Decision-making abilities. (f) Personality, including how the person copes with change or challenging situations. (g) Communication and sensory abilities including: (A) Hearing; (B) Vision; (C) Speech; (D) Use of assistive devices; and (E) Ability to understand and be understood. (h) Activities of daily living including: (A) Toileting, bowel, and bladder management; (B) Dressing, grooming, bathing, and personal hygiene; (C) Mobility - ambulation, transfers, and assistive devices; and (D) Eating, dental status, and assistive devices. (i) Independent activities of daily living including: (A) Ability to manage medications; (B) Ability to use call system; (C) Housework and laundry; and (D) Transportation. (j) Pain - pharmaceutical and non-pharmaceutical interventions, including how a person expresses pain or discomfort. (k) Skin condition. (l) Nutrition habits, fluid preferences, and weight if indicated. (m) List of treatments - type, frequency, and level of assistance needed. (n) Indicators of nursing needs, including potential for delegated nursing tasks. (o) Review of risk indicators including: (A) Fall risk or history; (B) Emergency evacuation ability; (C) Complex medication regimen; (D) History of dehydration or unexplained weight loss or gain; (E) Recent losses; (F) Unsuccessful prior placements; (G) Elopement risk or history; (H) Smoking. The resident's ability to smoke without causing burns or injury to themselves or others or damage to property must be evaluated and addressed in the resident's service plan; and (I) Alcohol and drug use. The resident's use of alcohol or the use of drugs not prescribed by a physician must be evaluated and addressed in the resident's service plan. (p) Environmental factors that impact the resident's behavior including, but not limited to: (A) Noise. (B) Lighting. (C) Room temperature. (6) If the information has not changed from the previous evaluation period, the information does not need to be repeated. A dated and initialed notation of no changes is sufficient. The prior evaluation must then be kept in the current resident record for reference. Stat. Auth.: ORS 410.070, 441.122, 443.450 Stats. Implemented: ORS 441.111, 441.114, 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 ensure move-in evaluations addressed all required elements and were completed prior to the resident being admitted to the facility for 1 of 1 sampled resident (#3). Findings include, but are not limited to: Resident 3 was admitted to the facility in 09/2026 with diagnoses including dementia. The resident's new move-in evaluation was completed on 09/04/26. The following elements were not addressed or had conflicting information in the move-in evaluation: * Pronouns and gender identity; * Memory, orientation, confusion and decision-making abilities; * Personality, including how the person copes with challenging situations; * Ability to use call system; * Housework and laundry; * Transportation; * Pain, including non-drug interventions to help with pain and how the person expresses pain or discomfort; * Recent losses; and * Elopement risk or history. In an interview on 10/06/26 at 1:30 pm, Staff 2 (Administrator’s Assistant) indicated the facility form did not reflect pronouns or gender identity and those would be added to the form. She acknowledged the other areas on the form should not be left blank. The need to complete move-in evaluations prior to a resident being admitted to the facility and to address all required elements was discussed with Staff 1 (Owner/Administrator) and Staff 2 on 10/06/26. They acknowledged the findings.

1.All Service plans will be up to date and in compliance and reviewed for accuracy. The resident noted on the survey has had service plan updated with all required components. An audit of all service plans for thorouness will be completed by compliance date. 2. Any one doing Evaluations and Service Plans will assure that all components of the evaluation are answered thoroughly whether initial or on-going. 3. This will be evaluated with each move-in and ongoing with 30 and 90 day service conferences and with changes of condition. 4. Resident Care Manager and Administrator

OAR 411-054-0055 (1)(j-k) Systems: Resident Right to Refuse (j) The resident or the person legally authorized to make health care decisions for the resident has the right to consent to, or refuse, medications and treatments.(k) The physician or other practitioner must be notified if a resident refuses consent to an order. Subsequent refusals to consent to an order will be reported as requested by the prescriber. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to notify the physician/practitioner when a resident refused to consent to orders for 1 of 1 sampled resident (#2) who had documented medication refusals. Findings include, but are not limited to: Resident 2 was admitted to the facility in 01/2024 with diagnoses including dementia. The resident's 09/01/26 through 10/05/26 MARs and 08/13/26 signed physician orders revealed the resident refused to consent to orders for the following medications: * Diclofenac sodium 1% gel (for pain) on four occasions; * Divalproex Sod DR 125 mg tablet (osteoarthritis) on one occasion; * Melatonin 3 mg tablet (for sleep) on one occasion; * Mirtazapine 7.5 mg tablet (for dementia) on one occasion; * Quetiapine 25 mg tablet (for anxiety/agitation) on one occasion; * Levothyroxine 25 mcg tablet (for thyroid) on one occasion; and * Acetaminophen extra strength 500 mg tablet (for pain) on three occasions. In an interview on 10/06/26 at 10:30 am, Staff 2 (Administrator’s Assistant) indicated the refusals were not communicated to the physician as ordered. The need to ensure the facility notified the physician or other practitioner if the resident refused consent to an order was discussed with Staff 1 (Administrator/Owner) and Staff 2 on 10/06/26. The staff acknowledged the findings.

1.Resident noted in SOD has had medication refusal notifications sent to their providers. Med Techs re-instructed on daily notifications unless otherwise noted by the PCP. 2. Weekly review of refusals will be completed by Resident Care Manager to assure compliance with notification. For residents with frequent refusals- parameters for notification will be requested from provider. For consistent refusals of certain medications, a request for provider review of appropriateness of continued order will be sent. If refusals are deemed to be behavioral in nature, a consideration for Behavioral Support will be made. 3. Daily and Weekly per policy 4. Resident Care Manager and Administrator.

OAR 411-054-0090 (5) Fire and Life Safety: Training for Residents (5) TRAINING FOR RESIDENTS. Residents must be instructed about the facility's fire and life safety procedures per OFC. (a) Each resident must be instructed within 24 hours of admission and re-instructed, at least annually, in general safety procedures, evacuation methods, responsibilities during fire drills, and designated meeting places outside the building or within the fire safe area in the event of an actual fire. This requirement does not apply to residents whose mental capability does not allow for following such instruction. (b) A written record of fire safety training, including content of the training sessions and the residents attending, must be kept. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure residents were instructed in fire and life safety procedures at least annually. Findings include, but are not limited to: Fire and life safety records were reviewed and discussed with Staff 1 (Administrator/Owner) and Staff 2 (Administrator’s Assistant) on 10/06/26. There was no documentation that residents were provided with fire training at least annually, related to general fire and life safety procedures, evacuation methods, responsibilities, and designated meeting places inside or outside the building in the event of an actual fire. In an interview on 10/06/26 at 10:30 am, Staff 2 indicated she was not aware of the need to repeat the training annually. Staff 1 acknowledged the need to provide the residents with annual fire and life safety training.

1. The Resident Care Manager or designee will oversee the annual fire safety training with each individual resident. All residents have had their Annual Fire Training completed at this time. 2. The Resident Care Manager or designee will meet with each Resident annually to go over the annual fire safety training. The Resident Care Manager or designee will have each Resident sign their attendance of this training and will have the information that was instructed attached to the signed attendance sheet as well as a copy offered to each Resident for their personal records. Residents who are not cognitvely able to understand will have this noted. 3. Trainings will be conducted upon move in and annually with each individual Resident. 4. Resident Care Manager and Administrator.

OAR 411-054-0034 (1)(c)(B)&(5)(a)(A-C) Resident Move-in & Evaluation: Res Evaluation (1) INITIAL SCREENING AND MOVE-IN. (c) Each resident record must, before move-in and when updated, include the following information: (B) To promote person-centered care, any variance from legal records, as indicated by the resident, regarding: (i) Name. (ii) Pronouns. (iii) Gender identity. (5) The resident evaluation must address the following elements: (a) For service planning purposes, if indicated by the resident, (A) Name (B) Pronouns. (C) Gender identity. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to ensure the initial evaluation addressed all required elements, including pronouns and gender identity, for 1 of 1 sampled resident (#3) whose initial evaluation was reviewed. Findings include, but are not limited to: Refer to C252.

1. The assessment tool has been updated to include Gender Identity and Preferred Pronouns. All residents have had their service plan updated for gender identity and preferred pronouns 2.See #1. 3. Initial and quarterly with service plan updates to assure this portion is answered for all residents. 4. Resident Care Manager 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: 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 C422.

Refer to C252, C305

OAR 411-057-0160(2b) Compliance with Rules Health Care (b) Health care services provided in accordance with the licensing rules of the facility. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to provide health care services in accordance with the licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to: Refer to C252 and C305.

See C 422