Cascades of Bend Retirement Community

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.

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).

This Rule is not met as evidenced by:
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.

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).

This Rule is not met as evidenced by:

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.

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

This Rule is not met as evidenced by:

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.

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.

This Rule is not met as evidenced by:

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 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.
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.

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.

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 livingbid: twice a dayCBG: capillary blood glucose or blood sugar CG: caregivercm: centimeterED: Executive DirectorF: FahrenheitHH: Home HealthLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterMT: Medication TechnicianOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayQI: quality improvementRCC: Resident Care CoordinatorRN: Registered NurseTAR: Treatment Administration Recordtid: 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.

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.

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 mcgc. 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.

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.

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.

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.