Cascades of Bend Retirement Community

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

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 OAR 333-150-000. Findings include, but are not limited to: On 02/25/26, between 10:00 am and 1:15 pm, the facility kitchen was observed, and the following was identified. 1. Areas in need of cleaning in the main kitchen: *Oven/grill - spills, carbon buildup; *Small appliances - food splatter; *Juice Machine – buildup around spigot; *Shelving above steam table – dusty; *Can opener - white, grey matter buildup, metal shavings, worn blade; *Flooring throughout kitchen - slick, buildup around edges, under/around appliances/doors; *Dishwasher - food debris build-up on top; *Coolers/freezers/ovens - food debris on handles/fronts; and *Floor drains - unclean, discolored. 2. Areas in need of repair/maintenance in main kitchen: *Cutting boards on deli coolers/steamtable/prep areas- scored, stained, non-cleanable. 3. Sanitation/Infection Control/Food Preparation in main kitchen: Surveyor found several prepared food items undated and/or expired in reach-in and deli cooler. Staff 1 (PIC/Dining Services Director) confirmed that the PH test strips were incorrect and was unaware of the type of chemical in use for the sanitation buckets. Correct test strips were ordered. 4. Cross Contamination/Handwashing/Glove Use in main kitchen: Surveyor observed a cook touching serving utensils, the dirty handle on the cooler, the boiled eggs, the cut lettuce, and the cheese wearing the same gloves. The cook proceeded to prepare the chef salad and then removed the gloves and placed them on the cutting board at the steamtable. Surveyor observed a cook touch the raw meat patty and the cheese with bare hands, then sanitized hands and immediately touched the bun. Surveyor observed a cook eating at the service line. The cook discarded the dirty dishes in the dish room and returned to work without washing hands her hands. Surveyor found the exteriors and handles of multiple kitchen appliances/coolers soiled with food debris. 5. Areas in need of cleaning/repair in The Pines Kitchenette: *Cutting boards - heavily scored, stained, non-cleanable; and *Juice machine - buildup around spigots. The areas of concern were observed and/or discussed with Staff 1 (PIC/Dining Services Director), Staff 2 (Executive Director) and Staff 3 (Associate Executive Director) at approximately 1:15 pm on 02/25/26. Staff acknowledged the findings.

1. All areas mentioned have been cleaned. Cutting boards that need to be replaced have been ordered. PH test strips have been delivered. 2. Cleaning logs will be checked when Dining Services Director (DSD) of Dining Room Supervisor (DRS) are present and checked weekly to ensure ongoing compliance. Education to be provided at dining staff meeting regarding labeling, dating, expired food. Education will be provided during meeting regarding contamination/handwashing/glove use to all dining staff. 3. Monday-Friday and when DSD or DRS are present. 4. Dining Services Director and Executive Director

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

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 OAR 333-150-000. Findings include but are not limited to: On 05/06/26, between 12:30 pm and 1:00 pm, the facility kitchen was observed, and the following was identified. 1. Areas in need of cleaning in the main kitchen: *Oven/grill - carbon buildup; *Juice Machine – buildup around spigots; *Coolers – food spills, food debris on handles; *Shelving above steam table by thermometers – dusty; *Can opener - white, grey matter buildup, metal shavings; and *Floor drains - unclean, discolored, non-cleanable. 2. Areas in need of repair/maintenance in main kitchen: *Cutting boards on deli coolers/steamtable/prep areas- scored, stained, non-cleanable. 3. Sanitation/Infection Control/Food Preparation in main kitchen: Surveyor found several food items unsealed, undated and/or expired in reach-in and deli coolers. Expired foods were discarded. Surveyor observed improper thawing of food. Staff made corrections. 4. Cross Contamination/Handwashing/Glove Use in main kitchen: *Coolers/freezers/ovens - food debris on handles. 5. Areas in need of cleaning/repair in The Pines Kitchenette: *Cutting boards - heavily scored, stained, non-cleanable; and *Juice machine - buildup around spigots. The areas of concern were observed and/or discussed with Staff 1 (Executive Director) and Staff 2 (Associate Executive Director) at approximately 1:00 pm on 05/06/26. Staff acknowledged the findings.

1. All areas listed were cleaned. -Education provided on ensuring all food is labeled, dated and covered correctly and expiration dates are checked. -Education provided on handwashing and cross contamination. 2. Cleaning lists were updated and education was provided to all dining associates to follow cleaning lists. 3. Three times per week by Dining Services Director. 4. Dining Services Director and Executive Director.

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.

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.

OAR 411-054-0025 (1) Facility Administration: Operation (1) FACILITY OPERATION. (a) The licensee is responsible for the operation of the facility and the quality of services rendered in the facility. (b) The licensee is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of their his or her employment duties.(c) The licensee is responsible for ensuring that the facility complies with the tuberculosis screening recommendations in OAR 333-019-0041.(d) The licensee is responsible for obtaining background checks on all subject individuals.

Based on observation, interview and record review, it was determined the facility failed to provide effective administrative oversight to ensure quality of care and services rendered in the facility. Findings include, but are not limited to: During the Kitchen survey, conducted 05/06/26, administrative oversight to ensure adequate Kitchen cleanliness rendered in the facility was found to be ineffective based on the number of visits. Refer to deficiencies in the report.

1. Please refer to C240.

OAR 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation.

Based on observation and interview, it was determined the facility failed to ensure the kitchen inspection survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to: Refer to C240.

1. Please refer to C240.

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

Based on observation, interview, and record review, it was determined the facility failed to ensure food was prepared, 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 facility kitchens, food storage areas, food preparation, and food service on 01/07/25 revealed splatters, spills, drips, and debris noted on: - Can opener blade and casing; - Small appliances on counters; - Timer and speaker on tray line; - Convection oven exterior including doors and knobs; - Stand mixer; - Interior and exterior of the ice cream freezer; - Shelving below the steam table; - Shelving and floors of reach-in and deli refrigerators; - Cage of air circulation fan in walk in refrigerator; - Dry storage flooring and food containers; - Interior of the microwaves on the tray line; - Dishes and cookware stored on open shelving and racks; - Garbage cans; - Interior of drawers in food prep area; - Open stainless steel shelving and metal rack shelving throughout the kitchen; - Flooring throughout the kitchen, including beneath shelving and equipment; - Walls throughout the kitchen; - Interior of drawers and cupboards in the beverage station; - Carts; - Drains throughout the kitchen and in the beverage station; - Walls, flooring, and equipment in the dishwashing area; - Underneath shelving and equipment throughout kitchen; and - Janitorial closet floor, sink, and drain. * There was no documented evidence of consistent monitoring of the temperatures of cooked foods, refrigerators, or the sanitizer solution. * Multiple staff preparing and serving food did not have long beard and/or hair restrained. * A serving utensil was left in a bin of undated, unlabeled food in the walk-in refrigerator and in a bin of food on the service line. * Prepared foods were dated as older than seven days. * Boxes were stored on the floor in the walk-in freezer. * Boxes were left open, exposing food, in the walk-in freezer. * Ice cream containers were left uncovered. * Foods noted to require refrigeration after opening were stored outside the refrigerator after being opened. * Dented can of food in the dry storage area; * Cutting boards on the steam table, the deli fridge, and the color code cutting boards were stained and deeply scored. * Uncovered, undated, and unlabeled prepared foods in the walk-in, deli, tray line, and beverage station refrigerators. * Packaged foods not dated when opened. * Dish washing racks were stored on the floor. * There were not lids for multiple garbage cans in food preparation areas. * Sanitizer towels were not stored submerged in the sanitizing solution. * Employee coats, purses, and jewelry were left on the service line. The areas in need of cleaning and the food storage concerns were reviewed with Staff 1 (Executive Director) and Staff 3 (Dining Services Director) on 01/07/25. They acknowledged the findings.

1. Kitchen was thoroughly cleaned. All splatters, spills, and debris were cleaned from all areas noted during most recent survey on 1/7/2025. -2. Dining associates attended a meeting on 1/16/2025 to discuss training for all tags in the kitchen. -All food unlabeled, undated and uncovered was thrown away. -Education and training was provided during Dining Meeting on importance of monitoring temperatures of cooked foods, refrigerators and the sanitizer solutions. -Education and training provided during Dining Meeting on importance of pulling back long hair or wearing hair nets. -Utensil left in a bin of food in the walk in was removed and education provided at Dining Meeting. -Dented can was thrown away. -Cutting boards and garbage can lids have been ordered. -A new area for coats, purses, etc. was created for kitchen staff. 2. Dining Director will manage cleaning schedule with Dining Room Supervisor. Training was provided to all dining staff on the tags. 3. Dining Director and/or Dining Room Supervisor will check once per day. 4. Executive Director and Dining Director.

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

Based on observation, interview, and record review, it was determined the facility failed to ensure food was prepared, and the kitchen was maintained, in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: a. Observations of the facility kitchens, food storage areas, food preparation, and food service on 06/04/2025 at 11:50 am revealed splatters, spills, drips, and/or debris on: *Interior of the refrigerator in beverage station; *Juice, water and ice dispenser in beverage station; *Carts holding drinkware; *Flooring under shelving and near tray line; *Microwave near tray line; *Steamer; *Oven and blender in the memory care kitchenette; and *Freezer in the memory care kitchenette. b. There was no documented evidence of consistent and correct temperature monitoring of food on the tray line. c. Multiple staff preparing and serving food did not have long beard and/or hair restrained. d. The interior of a refrigerator in the beverage station had standing water. e. A serving utensil was left in a bin of undated, unlabeled food in the deli refrigerator. f. Multiple ready-to-eat items were found to be either undated or were dated older than seven days. g. Multiple trays and/or bowls of uncovered, prepared food was found in the deli refrigerators. h. A bag of cheese was open, exposing food, in the deli refrigerator. i. Multiple bags of cereal were under the tray line and were open and undated. j. The toaster in the memory care kitchenette had an uncleanable surface. The need to ensure the Food Sanitation Rules are followed was reviewed with Staff 1 (Executive Director), Staff 2 (Associate Executive Director) and Staff 3 (Dining Services Director) at 1:20 pm on 06/04/25. They acknowledged the findings.

1. The main kitchen was thoroughly cleaned, including removal of all splatters and debris. - Memory care kitchenette was cleaned and organized. - Staff education was provided to all cooks and servers with long hair and/or beards to ensure proper hair restraints are used at all times. - An audit was conducted to identify any food or beverages that were not properly labeled and dated; all non-compliant items were discarded. 2. The Dining Services Director, in collaboration with the Dining Room Supervisor, will oversee the use and maintenance of daily cleaning checklists. - All kitchen and dining staff will be held accountable for completing these checklists consistently and accurately. 3. Monitoring Schedule: - Kitchen audits will be conducted five days per week, twice per day, to ensure continued compliance. 4. Dining Services Director and Executive Director

OAR 411-054-0030 (1)(a) Resident Services Meals, Food Sanitation Rule (1) The residential care or assisted living facility must provide a minimum scope of services as follows: (a) Three daily nutritious, palatable meals with snacks available seven days a week, in accordance with the recommended dietary allowances found in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables; (A) Modified special diets that are appropriate to residents' needs and choices. The facility must encourage residents' involvement in developing menus. (B) Menus must be prepared at least one week in advance, and must be made available to all residents. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served. Residents must be informed in advance of menu changes. (C) Food must be prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules).

OAR 411-054-0070 (3-4) Staffing Requirements and Training – Pre-service (3) PRE-SERVICE ORIENTATION FOR ALL EMPLOYEES. Prior to beginning their job responsibilities, all employees must complete orientation training regarding: (a) A review of their written position description with their job responsibilities. (b) RESIDENTS’ RIGHTS. Residents' rights and the values of community-based care, including the Department-approved LGBTQIA2S+ trainings. (A) Effective December 31, 2024, all staff must have completed the required training. All new staff, hired on and after January 1, 2025, must complete the required training prior to beginning job responsibilities. (B) The Department-approved LGBTQIA2S+ trainings shall address the elements described in paragraph (6)(b) of this rule. (c) Abuse and reporting requirements. (d) Fire safety and emergency procedures. (e) INFECTIOUS DISEASE PREVENTION. Prior to beginning their job responsibilities, unless the employee received the training described below within the 24-month period prior to the time of hiring, all employees must complete training addressing the prevention, recognition, control and reporting of the spread of infectious disease. (A) The Department, in consultation with the Oregon Health Authority, has determined this training must address the following curricula: (i) Transmission of communicable disease and infections, including development of a policy with criteria directing staff to stay home when ill with a communicable disease, so as not to transmit disease. (ii) Policy addressing respiratory hygiene and coughing etiquette. (iii) Standard precautions. (iv) Hand hygiene. (v) Use of personal protective equipment. (vi) Cleaning of physical environment, including, but not limited to disinfecting high-touch surfaces and equipment, and handling, storing, processing and transporting linens to prevent the spread of infection. (vii) Isolating and cohorting of residents during a disease outbreak. (viii) Employees must also receive training on the rights and responsibilities of employees to report disease outbreaks under ORS 433.004 and safeguards for employees who report disease outbreaks. (B) INFECTIOUS DISEASE TRAINING CURRICULUM. Pre-service infectious disease training curriculum must be approved by the Department before facilities may offer training to staff. (i) The pre-service training may be provided in person, in writing, by webinar or by other electronic means. (ii) Facilities or other entities that want to provide training curriculum to facilities must first present that curriculum to the Department for review and approval. (f) HOME AND COMMUNITY-BASED SERVICES (HCBS) TRAINING. All staff are required to complete the Department-approved HCBS training, as provided below: (A) Effective March 31, 2024, all staff must have completed the required training. (B) All new staff, hired on or after April 1, 2024, must complete the required training prior to beginning job responsibilities. (g) FOOD HANDLING. If the staff member's duties include preparing food, they must have a food handler's certificate. (4) PRE-SERVICE TRAINING FOR ALL DIRECT CARE STAFF. (a) DEMENTIA. Prior to providing care to residents, all direct care staff must complete an approved pre-service dementia training. (A) Documentation of dementia training: (i) A certificate of completion shall be issued to direct care staff who satisfactorily complete approved dementia training. Facilities shall also maintain records of all direct care staff who have successfully completed pre-service dementia training. (ii) Each facility shall maintain written documentation of continuing education completed, including required pre-service dementia training, for all direct care staff. (B) Portability of pre-service dementia training: After completing the pre-service training, if a direct care staff person is hired within 24 months by a different facility, the hiring facility may choose to accept the previous training or require the direct care staff to complete the hiring facility’s pre-service dementia training. (C) A certificate of completion must be made available to the Department upon request. (D) Pre-service dementia care training must include the following subject areas: (i) Education on the dementia disease process, including the progression of the disease, memory loss, and psychiatric and behavioral symptoms. (ii) Techniques for understanding, communicating, and responding to distressful behavioral symptoms, including, but not limited to, reducing the use of antipsychotic medications for non-standard uses. (iii) Strategies for addressing social needs of persons with dementia and engaging them with meaningful activities. (iv) Information concerning specific aspects of dementia care and ensuring the safety of residents with dementia, including, but not limited to, how to: (I) Identify and address pain. (II) Provide food and fluids. (III) Prevent wandering and elopement. (IV) Use a person-centered approach. (b) ORIENTATION TO RESIDENT. Pre-service orientation to resident: (A) Prior to providing personal care services for a resident, direct care staff must receive an orientation to the resident, including the resident’s service plan. (B) Direct care staff members must be directly supervised by a qualified person until they have successfully demonstrated satisfactory performance in any task assigned and the provision of individualized resident services, as applicable

Based on record review and interview, it was determined the facility failed to ensure all staff who prepare and serve food had active food handler's certificates (#4 and 5). Findings include but are not limited to: On 01/07/25, the surveyor reviewed employee records for active food handler's cards. Staff 4’s (Server) food handler's card on file was expired and Staff 5 (Cook) did not have a food handler card on file. Staff 1 (Executive Director) verified the staff did not have an active food handler’s cards and that their duties did include preparing and serving food to residents.

1. Every person who did not have a food handlers card completed it and printed it for their file. 2. Community has created a spreadsheet to keep track of food handler cards to maintain active and unexpired certificates. 3. Weekly. 4. Executive Director and Dining Director.

OAR 411-054-0070 (3-4) Staffing Requirements and Training – Pre-service (3) PRE-SERVICE ORIENTATION FOR ALL EMPLOYEES. Prior to beginning their job responsibilities, all employees must complete orientation training regarding: (a) A review of their written position description with their job responsibilities. (b) RESIDENTS’ RIGHTS. Residents' rights and the values of community-based care, including the Department-approved LGBTQIA2S+ trainings. (A) Effective December 31, 2024, all staff must have completed the required training. All new staff, hired on and after January 1, 2025, must complete the required training prior to beginning job responsibilities. (B) The Department-approved LGBTQIA2S+ trainings shall address the elements described in paragraph (6)(b) of this rule. (c) Abuse and reporting requirements. (d) Fire safety and emergency procedures. (e) INFECTIOUS DISEASE PREVENTION. Prior to beginning their job responsibilities, unless the employee received the training described below within the 24-month period prior to the time of hiring, all employees must complete training addressing the prevention, recognition, control and reporting of the spread of infectious disease. (A) The Department, in consultation with the Oregon Health Authority, has determined this training must address the following curricula: (i) Transmission of communicable disease and infections, including development of a policy with criteria directing staff to stay home when ill with a communicable disease, so as not to transmit disease. (ii) Policy addressing respiratory hygiene and coughing etiquette. (iii) Standard precautions. (iv) Hand hygiene. (v) Use of personal protective equipment. (vi) Cleaning of physical environment, including, but not limited to disinfecting high-touch surfaces and equipment, and handling, storing, processing and transporting linens to prevent the spread of infection. (vii) Isolating and cohorting of residents during a disease outbreak. (viii) Employees must also receive training on the rights and responsibilities of employees to report disease outbreaks under ORS 433.004 and safeguards for employees who report disease outbreaks. (B) INFECTIOUS DISEASE TRAINING CURRICULUM. Pre-service infectious disease training curriculum must be approved by the Department before facilities may offer training to staff. (i) The pre-service training may be provided in person, in writing, by webinar or by other electronic means. (ii) Facilities or other entities that want to provide training curriculum to facilities must first present that curriculum to the Department for review and approval. (f) HOME AND COMMUNITY-BASED SERVICES (HCBS) TRAINING. All staff are required to complete the Department-approved HCBS training, as provided below: (A) Effective March 31, 2024, all staff must have completed the required training. (B) All new staff, hired on or after April 1, 2024, must complete the required training prior to beginning job responsibilities. (g) FOOD HANDLING. If the staff member's duties include preparing food, they must have a food handler's certificate. (4) PRE-SERVICE TRAINING FOR ALL DIRECT CARE STAFF. (a) DEMENTIA. Prior to providing care to residents, all direct care staff must complete an approved pre-service dementia training. (A) Documentation of dementia training: (i) A certificate of completion shall be issued to direct care staff who satisfactorily complete approved dementia training. Facilities shall also maintain records of all direct care staff who have successfully completed pre-service dementia training. (ii) Each facility shall maintain written documentation of continuing education completed, including required pre-service dementia training, for all direct care staff. (B) Portability of pre-service dementia training: After completing the pre-service training, if a direct care staff person is hired within 24 months by a different facility, the hiring facility may choose to accept the previous training or require the direct care staff to complete the hiring facility’s pre-service dementia training. (C) A certificate of completion must be made available to the Department upon request. (D) Pre-service dementia care training must include the following subject areas: (i) Education on the dementia disease process, including the progression of the disease, memory loss, and psychiatric and behavioral symptoms. (ii) Techniques for understanding, communicating, and responding to distressful behavioral symptoms, including, but not limited to, reducing the use of antipsychotic medications for non-standard uses. (iii) Strategies for addressing social needs of persons with dementia and engaging them with meaningful activities. (iv) Information concerning specific aspects of dementia care and ensuring the safety of residents with dementia, including, but not limited to, how to: (I) Identify and address pain. (II) Provide food and fluids. (III) Prevent wandering and elopement. (IV) Use a person-centered approach. (b) ORIENTATION TO RESIDENT. Pre-service orientation to resident: (A) Prior to providing personal care services for a resident, direct care staff must receive an orientation to the resident, including the resident’s service plan. (B) Direct care staff members must be directly supervised by a qualified person until they have successfully demonstrated satisfactory performance in any task assigned and the provision of individualized resident services, as applicable

OAR 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation.

Based on observation, interview, and record review, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to:? Refer to C240.

Refer to C240.

OAR 411-054-0105 (2-4) Inspections and Investigation: Insp Interval (Amended 12/15/21)(2) The facility shall not interfere with a good faith disclosure of information by an employee or volunteer concerning abuse or other action affecting a resident's safety or welfare, as described in OAR 411-054-0028(4).(3) Staff of the Department shall visit and inspect every facility at least but not limited to once every two years for a full in-person survey to determine whether the facility is maintained and operated in accordance with these rules.(a) For each year during which a facility does not have a full survey, the Department shall conduct an in-person inspection of the kitchen and other areas where food is prepared for residents.(b) Subsection (a) will not go into effect until July 1, 2022.(c) Facilities not in compliance with these rules must submit, within ten days of receipt of the inspection report, a plan of correction that satisfies the Department.(d) The Department may impose sanctions for failure to comply with these rules.(4) Department staff may consult with and advise the facility administrator concerning methods of care, records, housing, equipment, and other areas of operation.

Based on observation and interview, it was determined the facility failed to ensure food was prepared, 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 facility kitchen, food storage areas, food preparation, and food service on 08/16/23 revealed splatters, spills, drips, and debris noted on:   - Can opener blade and casing; - Stand mixer; - Plate warmer and clean plates in the warmer; - Shelving below the steam table; - Shelving and floors of reach-in and walk-in refrigerators; - Dry storage shelving, flooring, and food containers; - Dishes and cookware stored on open shelving and racks; - Open stainless steel shelving and metal rack shelving throughout the kitchen; - Interior of drawers and cupboards in the beverage station; - Carts; - Underneath shelving and equipment throughout kitchen; and - Janitorial closet floor sink and drain heavily soiled. * Staff preparing food did not have long beard restrained. * A serving utensil was left in a bin of undated, unlabeled food in the refrigerator on the tray line. * Cutting boards on the steam table, the deli fridge, and the color coded boards were stained and deeply scored. * Scoops left in multiple bulk bins of food. * Uncovered, undated, and unlabeled prepared foods in the walk-in, deli, tray line, and beverage station refrigerators. * Packaged foods not dated when opened. * Dish washing racks were stored on the floor. * There were no strips to test the sanitizing solution to ensure it was at the correct ratios. The areas in need of cleaning and repair were reviewed with Staff 1 on 08/16/23. She acknowledged the findings.

1. Kitchen will be cleaned thoroughly, including floors,  storage area, food preparation area and all spills, drips, and debris noted during survey. -New stand mixer has been ordered and old one is not being used. -New can opener was ordered and current one was cleaned. -All opened containers without label/date were thrown away. Provided education to staff regarding importance of labeling/dating on day of survey. -Hair/Beard nets ordered. -Test strips for sanitizing solution ordered. -Dish washing racks are being stored on racks, not the floor. Education provided day of survey. -A meeting with all dining services team members occurred on 8/24/2023 to provide education on all findings during survey. -Cleaning checklists were revised and posted. 2. Executive Director and Associate Executive Director will check kitchen cleanliness and storage each day to ensure cleaning checklists and storage procedures are being done properly. 3. Three times per week. 4. Executive Director and Associate Executive Director.

Based on observation and interview, it was determined the facility failed to ensure food was prepared, and the kitchen was maintained, in accordance with the Food Sanitation Rules OAR 333-150-000. This is a repeat citation. Findings include, but are not limited to: Observations of the facility kitchen, food storage areas, and food preparation on 10/26/23 revealed splatters, spills, drips, and debris noted on:   - Can opener blade; - Stand mixer; - Dry storage shelving, flooring, and food containers; - Dishes and cookware stored on open shelving and racks; - Open stainless steel shelving and metal rack shelving throughout the kitchen; and - Underneath shelving and equipment throughout kitchen. * Staff preparing food removed their hat and placed it on food preparation area. * Dishwasher did not change gloves between handling dirty and clean dishes. * Staff preparing food did not change gloves between tasks. * Tongs left in containers of food. * Uncovered, undated, and unlabeled prepared foods in the walk-in, deli, and tray line reach in refrigerators. * Packaged foods not dated when opened. * Opened, uncovered foods in the dry storage. The above information was reviewed with Staff 3 (Dietary Services Director) on 10/26/23. He acknowledged the findings.

1. Kitchen was thoroughly cleaned. All splatters, spills, and debri were cleaned from all areas noted during most recent survey on 10/26/23. All food unlabeled, undated and uncovered was thrown away. *Associate that removed their hat was educated on proper sanitation and hand washing. He understands that he should go to break room to adjust his hat and then wash his hands when coming back into the kitchen. *Dishwasher and all staff were educated on glove sanitation and properly handling clean/dirty dishes as well as changing gloves between tasks. *Staff were educated on the importance of not leaving utensils in food containers. * Educated staff on importance of food safety and sanitation. All staff will date/label and cover food going forward. 2. Dining Services Director will frequently check for labels and dates in the kitchen. Dining Services Director will maintain a cleaning schedule. 3. Dining Services Director will check the cleaning schedule and the labeling/storage system once per day. 4. Executive Director and Dining Services Director.

Based on interview and observation, it was determined the facility failed to ensure their relicensure survey plan of correction was implemented and satisfied the Department. Findings include, but are not limited to: Refer to C 240.

Refer to C240.

The findings of the kitchen inspection, conducted 08/16/23, 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 first revisit to the kitchen inspection of 08/16/23, conducted 10/26/23, 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 second revisit to the kitchen inspection of 8/16/23, conducted 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, interview and record review, it was determined the facility failed to ensure service plans were reflective of residents' needs and provided clear direction to staff for 1 of 3 sampled residents (#2) whose service plans were reviewed. Findings include, but are not limited to: Resident 2 was admitted to the facility in 09/2021 with diagnoses including dementia. Observations of the resident, interviews with staff from 08/22/22 to 08/23/22, review of the service plan, dated 08/02/22, Charting Notes, incident reports, physician communication, and hospice documentation showed the service plan was not reflective of the resident's current care needs and did not provide clear direction to staff in the following areas: * Sleeping pattern and preferences; * The use of compression hose; * Incontinent product use; * Assistance with dressing; * Hospices services; and * Hearing Aid use. The need to ensure resident service plans were reflective of current care needs and provided direction to staff was discussed with Staff 1 (ED) and Staff 2 (RN). They acknowledged the findings. 2. Resident 1 was admitted to the facility in 07/2022 with diagnoses including obesity. Observations of the resident, interviews with staff, review of the updated service plan from 08/17/22, and subsequent temporary service plans were reviewed during the survey and showed the plan was not reflective of the resident's current status or failed to provide specific instruction and precautions to staff in the use of side rails. On 08/23/22, the need to ensure service plans were reflective of residents' needs and provided clear direction to staff regarding the delivery of services was discussed with Staff 1 (ED) and Staff 2 (RN). They acknowledged the findings.

Resident 2 service plan updated on August 23, 2022 to reflect sleeping pattern and preferences; incontinent product use; assistance with dressing; Hospice services; and hearing aid use. Resident 1 service plan updated on August 23, 2022 to provide specific instruction and precautions to staff in the use of siderails. A service plan audit will be completed by October 15, 2022. Wellness Director will be responsible for ongoing compliance.

Based on interview and record review, it was determined the facility failed to ensure residents' MARs were accurate and provided clear instruction and parameters for administration of PRN medications for 1 of 3 sampled residents (#1) whose MARs were reviewed. Findings include, but are not limited to: Resident 1 was admitted to the facility in 07/2022. Review of the residents MAR, between 08/01/22 - 08/22/22, identified the following deficiencies: a. Resident 1 was prescribed the following PRN medications for constipation: * Polyethylene Glycol 3350 powder; and * Senna 8.6 mg. Resident 1 was prescribed the following PRN medications for insomnia: * Trazodone 50 mg; and * Melatonin 10 mg.     The MAR failed to include clear parameters and instructions to unlicensed staff for when each medication should be administered. b. The following medications lacked reasons for use on the resident's MAR: *Folic Acid 1 mg; *QVAR Redihaler 40 mcg; * Senna 8.6 mg; *Thermotabs; and *Vitamin B-12 2,500 mcg c. Resident 1's PRN Albuterol 90 mcg lacked specific parameters for frequency of use. d. Resident 1's service plan, dated 08/17/22, indicated the resident had allergic reactions to Prednisone. The MAR failed to identify Prednisone as an allergy. On 08/23/22, the need to ensure MARs were accurate and included parameters for PRN medications was discussed with Staff 1 (ED) and Staff 2 (RN). They acknowledged the findings.

Resident 1: PRN constipation, insomnia, and Albuterol medication orders were clarified in MAR, with specific parameters and instructions to unlicensed staff for when medications should be administered, on August 24, 2022. Wellness Director L.P.N./R.N. will complete PRN medication audit. PRN audit will be completed by October 15, 2022. Wellness Director L.P.N./R.N. will be responsible for reviewing all new PRN medication orders upon receipt to ensure parameters are documented in the MAR. Wellness Director L.P.N./R.N. will be notified of new orders and will be responsible for ensuring parameters are appropriate and resident specific. Wellness Director L.P.N./R.N. will be responsible for reviewing all PRN medication orders quarterly to ensure resident specific parameters are documented in the MAR. Wellness Director L.P.N./R.N. will document PRN parameter review status on RN quarterly assessments. Wellness Director L.P.N./R.N. will be responsible for ongoing compliance Resident 1 medications reasons for use were updated on August 23, 2022. Wellness Director L.P.N./R.N. will complete a MAR audit to ensure all medications have a reason for use.  MAR audit will be completed by October 15, 2022. Wellness Director L.P.N./R.N. will be responsible for ongoing compliance. Resident 1 known drug allergies were entered into the MAR on August 23, 2022. Wellness Director L.P.N./R.N. will complete a MAR audit to ensure all drug allergies are entered into the MAR. The MAR audit will be completed by October 15, 2022. Wellness Director L.P.N./R.N. will be responsible for ongoing compliance.

Based on interview and record review, it was determined the facility failed to implement an acuity-based staffing tool (ABST) that met the regulation. Findings include, but are not limited to: There was no documented evidence the facility was using an ABST that would determine a staffing plan reflective to meet the 24-hour scheduled and unscheduled needs of residents and included all the required ABST elements. The requirements of the ABST were discussed with Staff 1 (ED) on 08/22/22. She acknowledged the current acuity tool in use by the facility did not include all the required information and did not generate a staffing plan.

On August 30, 2022, The Oregon Department of Human Services ABST was implemented. Current staffing plan reviewed and confirmed compliance with consistently staffing to the levels, intensity, and qualifications indicated by the ABST. The Wellness Director L.P.N./R.N., Executive Director, and/or designee will update the Oregon Department of Human Services ABST as outlined in OAR 411-054-0037 and ensure that current staffing plan is in compliance with consistently staffing to the levels, intensity, and qualifications indicated by the ABST.

Based on interview and record review, it was determined the facility failed to ensure Fire drills were conducted in accordance with Oregon Fire Code. Findings include, but are not limited to: The facility Fire and Life safety records from March 2022 through July 2022, failed to consistently document the following required fire drill components: *Escape route used; *Number of occupants evacuated; and *Evidence alternate routes were used during fire drills. On 08/22/22, the need to ensure fire drills had documented evidence of all required components was discussed with Staff 1 (ED). She acknowledged the findings.

On August 23, 2022, Cascade Living Group "Oregon-Fire Drill Report" was updated to document the escape route used; and number of occupants evacuated; and evidence alternate routes were used during fire drills. Plant Operations Director and/or Designee will implement the updated "Oregon-Fire Drill Report" for fire drills beginning in September 2022.

Based on observation and interview, it was determined the facility failed to ensure all exterior pathways were maintained in good repair and the grounds were orderly and free of litter and refuse. Findings include, but are not limited to: The facility grounds were toured on 08/22/22 and the following was observed: * Drop-offs greater than 12 inches from the sidewalk to the adjacent lawn and planting beds; and * Refuse and debris around the building and in resident window wells. The building exterior was reviewed with Staff 1 (ED). She acknowledged the findings.

CS Construction, Botanical Landscaping Inc. and/or Cascades of Bend will install topsoil and/or landscaping product to ensure sidewalk drop-offs are not greater than 12 inches by October 15, 2022. CS Construction and Cascades of Bend will remove refuse and debris around the building and in resident window/PTAC wells by October 15, 2022. Plant Operations Director will be responsible conducting weekly audits to ensure the sidewalk drop-offs are not greater than 12 inches and exterior grounds and window PTAC are free of refuse and debris Plant Operations Director will be responsible for ongoing compliance.

The findings of the re-licensure survey, conducted 08/22/22 to 08/23/22, are documented in this report. The survey was conducted to determine compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities and Home and Community Based Services Regulations OARs 411 Division 004. 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 08/23/22, conducted on 12/05/22, are documented in this report. It was determined the facility was in compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities and Home, and Community Based Services Regulations OARs 411 Division 004.