Brookdale Medford

Based on observation and interview, it was determined the facility failed to ensure food was handled, and the kitchen was maintained, in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: Observations of the facilities kitchen, food storage areas, food preparation, and food service on 09/13/23 revealed: * Splatters, spills, debris, and drips, noted on: - Stand mixer; - Can opener blade and casing; - Ice machine door and vents; - Walls throughout the kitchen; - Flooring and cove base throughout the kitchen; - Dry storage area shelving and food containers; - Range hood vents; - Dishes and cookware stored on open shelving and racks; - Stainless steel and metal rack shelving surfaces, legs, and feet; - Underneath shelving and equipment throughout kitchen; and - Hand washing area including walls, caulking, and equipment. - The dishwashing area walls, caulking, floors, and equipment; - Both sides and behind the range, grill, and oven; - Behind and underneath appliances; and - The surface and underneath the tray line steam table and plate warmer; * Dish racks were stored directly on the floor. * Dented cans were noted in the dry food storage. * Cutting boards were stained and deeply scored. * Staff were observed to not change gloves between tasks before handling ready to eat foods. * Staff were observed to not sanitize or wash hands upon entering the kitchen. * Staff with long painted nails were observed to handle and serve food without gloves. * Caregiving staff assisting with meal service and delivery were not using aprons. * The high temperature dish sanitizer was not reaching the required 180 Fahrenheit needed to sanitize the dishes. Staff 3 (Maintenance Tech) immediately scheduled the machine for service and turned up the temperature of the kitchen water heater. The Surveyor, Staff 2 (Dining Coordinator), and Staff 3 toured the kitchen. The food handling, hand hygiene process, and areas in need of cleaning and repair were reviewed with Staff 1 (Executive Director) and Staff 2. They acknowledged the findings.

1. All areas of the kitchen including, but not limited to, areas specified in the statement of deficiencies will be deep cleaned with all dietary staff and a third party professional cleaning company that specializes in commercial cleaning services. After this is conducted the cleaning will be maintained by community staff follow a community schedule. Dietary staff who are involved with food preparation and handling and care staff who are involved with food handling and serving will be re-trained in food safety fundamentals that includes proper hygiene. The dishwasher machine had scheduled maintenance completed 9/22. Maintenance Director turned up kitchen water heater temperature to allow the dishwasher to reach the required 180 degrees Fahrenheit 2. Daily cleaning schedule has been placed in the kitchen and assigned to dietary staff. This cleaning log includes all areas noted in the findings. Caregiving staff who service meals will be receive re-training on proper service that includes food safety fundamentals and proper use of aprons and personal hygiene. Water heater temperature raised in kitchen water heater to allow dishwasher machine to reach required temperature setting. 3. Kitchen cleaning logs will be monitored by the Dining Services Director daily 5x per week. Executive Director will view logs for accuracy and completion of duties on a weekly basis. Temeprature logs will be reviewed by Dining Services Director 5x per week for maintain required temperatures and Executive Director will view logs weekly for required temperatures.  The caulking around areas of the dish room and hand washing area will be schdueld to be re-caulked by maintenance on a quarterly basis. Dining Services Director will conduct weekly inspections of proper food preparations and handling. 4. The Executive Director, and or designee, and the Dining Services Director will be responsible for managing all corrections are in place and for monitoring ongoing compliance.

The findings of the kitchen inspection, conducted 09/13/23, 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.

The findings of the revisit to the kitchen inspection of 09/13/23, conducted on 02/12/24, 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, and Oregon Health Service Food Sanitation Rules OARs 333-150-0000.

Based on observation and interview, it was determined the facility failed to ensure the kitchen was kept clean and in good repair, and food was prepared and served in accordance with the Food Sanitation Rules OAR 333-150-00. Findings include, but are not limited to: 1. On 04/25/22 at 1:00 pm, Staff 11 was observed and the following was noted: *Staff 11 prepared salad with plastic gloved hands; *During the preparation of the salad, Staff 11 walked away from the tray line and went to the refrigerator to retrieve two containers including sliced tomatoes and cucumbers.  Staff 11 grabbed the refrigerator handle with the gloved hands; *Staff 11 went back to the tray line without changing gloves or washing his hands; *Staff 11 was observed touching sliced tomatoes and cucumbers with the same gloved hands; *Staff 11 walked away from the tray line again, went to the dry storage area to retrieve a large container of salad dressing and returned to the tray line without changing gloves or washing hands; and *Staff 11 was observed touching sliced cucumbers with the same gloved hands. During the observation, Staff 11 did not change his gloves or wash his hands. On 04/25/22 at 1:35 pm, the observation was shared with Staff 1 (ED) and infection control practice including washing hands and changing gloves was discussed. 2. Observation of the kitchen on 04/25/22 from 12:42 pm to 1:12 pm, revealed the following areas needed cleaning and repair: Beverage countertop and cabinet:   * Side of the countertop, next to the trash can, had gouges and splinters;   * Front and side towel dispenser was sticky to the touch;   * Interior of several cabinets and drawers had brown matter and food debris;   * The cabinet below the hand washing sink, had black and brown matter; and   * The metal shelf behind the hand washing sink had brown matter and rusted metal. Kitchen area:   *The door and the door frame was chipped and gouged;   *The wall behind of the kitchen door had food spills and debris;   *The drain underneath the sink next to the ice maker had thick black and brown matter;   *Ice maker lid was sticky to the touch;   *Ice maker filter had layers of dust;   *Microwave handle was sticky to the touch;   *Drains underneath of 2-compartment sink had black and brown matter;   *Sink back splash had brown matter;   *Interior of a free-standing refrigerator had food spills and debris;   *Soap dispenser near the hand washing sink had brown matter and food debris;   *The wall around the 2-compartment sink had food debris and brown matter;   *The ceiling, around the 2-compartment sink had food debris;   * Walls throughout the kitchen had multiple spills, smears and splatters; and   * A mixer surface was sticky to the touch. Dry food storage area:   *The ceiling had brown spots and food debris; and   *Walls throughout the storage area had multiple scrapes. Dish washing area:   *The wall throughout the area had brown matter, food spills and debris;   *The surface dishwasher was sticky to the touch; and   *A metal ceiling vent had brown matter and rusted metal. Floor:   * Station II pathway floors and baseboards had thick black matter build-up and food debris in the corners. On 04/25/22 at 1:35 pm, the kitchen was toured with Staff 1 (ED) and the above areas were reviewed.  Staff acknowledged the above areas needed cleaning and repair.

1) All areas of the kitchen including, but not limited to, areas specified in the statement of deficiencies were cleaned at time of survey and then will be deep cleaned through a third-party professional cleaning company that specializes in commercial cleaning services by complaince date and then maintained by community staff following a cleaning schedule. Gouged and splintered areas have been identified and sanded. Kitchen staff who are involved with food preparation and handling will be re-trained in infection control and food safety and will obtain a new food handlers card. 2) Daily Cleaning schedule has been placed in the kitchen, and will be reviewed weekly, which includes all areas noted in the findings. Kitchen staff who are involved with food preparation and food handling will be retrained in food safety by obtaining a new food handlers card. 3) Kitchen cleanliness will be monitored on a weekly basis. Food preparation will be monitored on a weekly basis. 4) The Executive Director, or designee, and the Dining Services Manager will be responsible for monitoring continued compliance.

The findings of the re-licensure survey conducted 04/25/22 through 04/27/22 are documented in this report. The survey was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities and OARs 411 Division 004 Home and Community Based Services Regulations. 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

The findings of the revisit to the re-licensure survey of 04/27/22, conducted 08/01/22 are documented in this report. It was determined the facility was in substantial compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities.