Print Inspection: TTBI

The findings of the kitchen inspection, conducted on 07/13/22, are documented in this report. The survey was conducted to determine compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services- Meals, OARs 411 Division 57 for Memory Care Communities, and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

Tag numbers beginning with the letter C refer to the Residential Care and Assisted Living rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.

Abbreviations possibly used in this document:

ADL:activities of daily living

bid:twice a day

CBG:capillary blood glucose or

blood sugar

CG:caregiver

cm:centimeter

ED:Executive Director

F:Fahrenheit

HH:Home Health

LPN:Licensed Practical Nurse

MA:          Medication Aide

MAR:Medication Administration

Record

MCC:Memory Care Community

mg:milligram

ml:milliliter

MT:Medication Technician

OT:Occupational Therapist

PT: Physical Therapist

PRN:as needed

qd:every day or daily

qid:four times a day

QI:     quality improvement

RCC:       Resident Care Coordinator

RN:     Registered Nurse

TAR:     Treatment Administration

Record

tid:           three times a day

Based on observation and interview, the facility failed to exercise reasonable precautions against any condition that may threaten the health, safety or welfare of residents. Findings include, but are not limited to:

Per Oregon Administrative Rule 333-019-1011(6), (8) and (10), persons employed in an assisted living or residential care facility are required to wear a face mask while they are in the facility except when the employee is alone in a closed room.

Upon entering the facility for the survey on 07/13/22 at 10:30 am, some administrative staff and direct care staff were observed not wearing face masks.

The need to ensure staff fully and consistently complied with masking requirements was discussed with Staff 1 (ED) during the exit meeting on 07/13/22. No further information was provided.

Staff to watch infectious control training and practice all requirements moving forward.

All staff prior to being on the floor will have infectious control certificate in training binder and will practice proper methods on every shift.

Weekly

Memory Care Director and or their designee in their absence.

Based on observation and interview, it was determined the facility failed to ensure food was prepared in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to:

The annual kitchen inspection was conducted on 07/13/22 and revealed the following:

* Raw meat being thawed above fruit;

* Multiple food items in the walk in refrigerator was not covered or dated;

* Pasteurized eggs were not being used when cooking eggs with soft yolks;

* Area under dishwasher had black substance and grease dripping down the wall;

* Staff not washing hands when entering the kitchen;

* Multiple food surfaces located above and below food prep areas had food crumbs and debris on them;

* Ice scoop was left in the machine in the ice.

* Freezer had melted chocolate ice cream on base of the freezer;

* Dessert items were left in the oven with no date;

* Refrigerator shelves had dried food and spilled fluids on them;

* Resident let her dog on one of the dining room tables before lunch service; and

* Tile under service window had black substance along the top.

A tour of the kitchen was conducted on 07/13/22 with Staff 1 (ED) and Staff 5 (Memory Care Director). Staff 1 and Staff 5 acknowledged the areas of kitchen needing cleaning.

The need to ensure the facility prepared food in accordance with the Food Sanitation Rules OAR 333-150-000 was discussed with Staff 1 and Staff 5 on 07/13/22. They acknowledged the findings.

1) Deep cleaning of the areas noted (surfaces, flooring, dishwasher area, walls). Cleaning will be completed by 8/11/2022. In-service for staff training on handwashing, cleaning, and food storage will be completed by 8/10/2022.

2) Routine kitchen walk throughs to oversee storage of food and beverage area. Routine review of cleaning schedules

3)  Weekly

4) Dining Services Director or designee with oversight by Executive Director

Based on observation, interview and record review, 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 C 160 and C 240.

Refer to Plan for C160 and C 240