Aging and People with Disabilities
Safety, Oversight and Quality
Print Inspection: WGCT
Provider Information
390 NW 2ND AVE
Canby, OR 97013
- Provider ID
- 50R283
- Administrator
- STACY ZIMMERMAN
- Phone
- (503) 266-3031
- ed@countrysidelivingcanby.com
Inspection Details
- Date
- 6/12/2024
- Event ID
- WGCT
- Inspection type(s)
- State Licensure
- Deficiencies cited
- 3
Citation Details
C0000: Comment
- Visit Number
- 1
- Visit Date
- 6/12/2024
- Corrected Date
- N/A
- Details
-
The findings of the kitchen inspection, conducted 06/12/24, 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 and Oregon Health Service Food Sanitation Rules OARs 333-150-0000 and OARs 411 Division 57 for Memory Care Communities.
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.
- Visit Number
- 2
- Visit Date
- 7/25/2024
- Corrected Date
- N/A
- Details
-
The findings of the first re-visit to the re-licensure survey of 06/12/24, conducted 07/25/24, are documented in this report. It was determined the facility was in substantial compliance with the OARs 411-054-0030 for Residential Care and Assisted Living Facilities for Resident Services- Meals, Oregon Health Service Food Sanitation Rules OARs 333-150-0000 and OARs 411 Division 57 for Memory Care Communities.
C0240: Resident Services Meals, Food Sanitation Rule
- Visit Number
- 1
- Visit Date
- 6/12/2024
- Corrected Date
- N/A
- Details
-
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 06/12/24 at 10:30 am, the facility kitchen was observed to need cleaning in the following areas:
* Ceiling in dishwashing area above clean dishes - buildup of dust;
* Wall behind spray hose and below dishrack shelf in dishwashing area - black matter buildup;
* Wall behind stove/grill - grease drips;
* Side and front of stove/grill and ledges on front of stove/grill - food drips and grease;
* Frame of door to dining room - buildup of dust;
* Ceiling vent/light cover/sprinkler head above steam table - dust build up; and
* Wall near ceiling above fire alarm - dust build up.
Improper food storage:
* Bins containing dry food under prep counter and in dry storage did not have lids securely closed, creating a potential for cross contamination.
The areas of concern were discussed with Staff 1 (Executive Chef) and Staff 2 (Executive Director) on 06/12/24. The findings were acknowledged.
- Plan of Correction
-
*Area cleaned with disinfectant and added duty to diet aide weekly cleaning schedule kitchen manager to ensure completion weekly
*Daily cleaning added to night diet aide duties monthly maintenance inspection. Area painte and cleaning added to tells system to complete quarterly provied by maintanence director
*PM cook degreased on 6/12/24 weekly cleaning schedule monitored by kitchen manager weekly
*New stove ordred waiting on scheduled delivery for 7/24/2024
*Kitchen meeting held on 6/25/2024 fans on during cooking hours to reduce buildup of dust. Area cleaned same day added to monthly tells system for monthly cleaning kitchen manager to monitor
* Painted and cleaned provided by maintanence director PM closing duty weekly using damp cloth and disinfectant
- Visit Number
- 2
- Visit Date
- 7/25/2024
- Corrected Date
- 6/13/2024
- Details
-
There are no detail notes for this visit.
Z0142: Administration Compliance
- Visit Number
- 1
- Visit Date
- 6/12/2024
- Corrected Date
- N/A
- Details
-
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.
- Plan of Correction
-
*New food grade dry storage bins purchaced that securley close. Labeled to remind staff to keep closed at all times
- Visit Number
- 2
- Visit Date
- 7/25/2024
- Corrected Date
- 6/13/2024
- Details
-
There are no detail notes for this visit.