Provider Details

Aging and People with Disabilities

Safety, Oversight and Quality

Oregon Department of Human Services Logo

Print Inspection: WGCT

Provider Information


Countryside Living Memory Care

390 NW 2ND AVE
Canby, OR 97013

Provider ID
50R283
Administrator
STACY ZIMMERMAN
Phone
(503) 266-3031
Email
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.