Oaktree Residential Living

Based on interview and record review, it was determined the facility failed to ensure 4 of 4 newly hired staff (#s 5, 6, 7, and 8) completed all required pre-service orientation and/or dementia training within the required timeframes. Findings include, but are not limited to:



Staff training records reviewed on 11/04/24 identified the following:



1. Staff 5 (CG), hired 04/10/24, Staff 6 (CG), hired 05/22/24, and Staff 7 (MT), hired 03/21/24, completed their pre-service dementia training on 05/09/24, 08/22/24, and 06/29/24, respectively, which was after they began providing care to residents.



2. Staff 5, hired 04/10/24, Staff 6, hired 05/22/24, and Staff 7, hired 03/21/24, took their Infectious Disease Prevention course on 10/20/24, 10/15/24, and 10/15/24, respectively, which was after they began providing care to residents.



3. Staff 6, hired 05/22/24, and Staff 7, hired 03/21/24, took the Home and Community Based Services (HCBS) course, on 06/05/24, which was after they began providing care to residents.



4. Staff 8 (Cook), hired 07/22/24, lacked documentation of completion of the HCBS course.



The need to ensure all pre-service orientation and dementia training was completed within the required timeframes was discussed with Staff 1 (Administrator), Staff 2 (Co-Administrator), and Staff 3 (RCC), on 11/04/24. They acknowledged the findings.

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 interview and record review, it was determined the facility failed to ensure 2 of 3 sampled long-term direct care staff (#s 9 and 10) completed a minimum of 12 hours of annual in-service training, including at least six hours of dementia care and infectious disease training. Findings include, but are not limited to:

Staff training records reviewed on 11/04/24 identified the following:

There was no documented evidence Staff 9 (CG) and Staff 10 (CG), hired 03/01/21 and 03/16/12, respectively, completed at least 12 hours of training based on their anniversary date of hire related to the provision of care in CBC, including infectious disease training and a minimum of six hours of training on dementia care topics.

The need to ensure and document that long-term direct care staff completed the required number of hours of annual in-service training based on their anniversary date of hire, was discussed with Staff 1 (Administrator), Staff 2 (Co-Administrator), and Staff 3 (RCC) on 11/04/24 at 3:30 pm. They acknowledged the findings.

OAR 411-054-0070 (6-8) Annual and Biennial Inservice for All Staff

(6) ANNUAL AND BIENNIAL INSERVICE FOR ALL STAFF.

(a) Annual infectious disease training requires the following:
(A) Administrators and employees will be required to complete annual training on infectious disease outbreak and infection control. Such training will be included within the current number of required annual training hours and will not necessitate additional hours of training.
(B) Annual in-service training must be documented in the employee record.

(b) Biennial LGBTQIA2S+ training requires the following:
(A) Administrators and employees shall be required to complete biennial training addressing LGBTQIA2S+ protections, as described in this section. The facility is responsible for the cost of providing this training to all facility staff.
(i) Each facility shall designate two employees, one who represents management and one who represents direct care staff by July 1, 2024. It is acceptable for the designated employee representing management to generally be housed offsite, but the direct care representative must be onsite.
(ii) The designated employees shall serve as points of contact for the facility regarding compliance with the preservice and biennial training requirements. These individuals shall develop a general training plan for the facility.

(B) Facilities must select the LGBTQIA2S+ training to be used by the facility by either:
(i) Choosing to use the standard Department-approved biennial LGBTQIA2S+ training, or
(ii) Applying to the Department to request approval of a biennial LGBTQIA2S+ training to be provided by the facility.

(C) ORS 441.116 requires all LGBTQIA2S+ trainings address:
(i) Caring for LGBTQIA2S+ residents and residents living with human immunodeficiency virus.
(ii) Preventing discrimination based on a resident’s sexual orientation, gender identity, gender expression or human immunodeficiency virus status.
(iii) The defined terms commonly associated with LGBTQIA2S+ individuals and human immunodeficiency virus status.
(iv) Best practices for communicating with or about LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including the use of an individual’s chosen name and pronouns.
(v) A description of the health and social challenges historically experienced by LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including discrimination when seeking or receiving care at care facilities and the demonstrated physical and mental health effects within the LGBTQIA2S+ community associated with such discrimination.
(vi) Strategies to create a safe and affirming environment for LGBTQIA2S+ residents and residents living with human immunodeficiency virus, including suggested changes to care facility policies and procedures, forms, signage, communication between residents and their families, activities, in-house services and staff training.
(vii) The facility, individual or entity providing the training must demonstrate a commitment to advancing quality care for LGBTQIA2S+ residents and residents living with human immunodeficiency virus in this state.

(D) The proposal for training submitted by a facility, entity, or individual shall include:
(i) The regulatory criteria described in paragraph (C) of this section as part of the proposal.
(ii) The following elements must be included in the proposal:
(I) A statement of the qualifications and training experience of the facility, individual or entity providing the training;
(II) The proposed methodology for providing the training either online or in person.
(III) An outline of the training.
(IV) Copies of the materials to be used in the training.
(iii) The Department will review the materials and determine whether to approve or deny the training. No later than 90 days after the request is received, the Department will inform the facility in writing of the Department’s decision.

(c) Annual Home and Community-Based Services (HCBS) training requires the following:
(A) All staff will be required to complete annual training concerning the Home and Community-Based Services regulations.
(B) Annual in-service training must be documented in the employee record.
(C) These annual trainings will be required as of April 1, 2025.

(7) ANNUAL IN-SERVICE TRAINING FOR DIRECT CARE STAFF.
(a) All direct care staff must complete and document a minimum of 12 hours of in-service training annually on topics related to the provision of care for persons in a community-based care setting, including training on chronic diseases in the facility population, LGBTQIA2S+ and dementia training. Annual in-service training hours are based on the anniversary date of hire.
(b) Requirements for annual in-service dementia training:
(A) Except as provided in paragraph (B) of this section, each direct care staff must complete 6 hours of annual in-service training on dementia care.
(B) Exception: Staff hired prior to January 1, 2019 must complete 6 hours of dementia care in-service training by the anniversary of their hire date in 2020 and annually thereafter.
(C) Dementia care training may be included in the required minimum 12 hours of annual in-service training described in subsection (a) above.
(D) Dementia care training must reflect current standards for dementia care and be informed by the best evidence in the care and treatment of dementia.
(E) The facility shall determine the competency of direct care staff in dementia care in the following ways:
(i) Utilize approved dementia care training for its direct care staff, coupled with methods to perform a competency assessment as defined in OAR 411-054-0005(19).
(ii) Ensure direct care staff have demonstrated competency in any duty they are assigned. Facility staff in a supervisory role shall perform assessment of each direct care staff.
(iii) Maintain written documentation of all dementia care training completed by each direct care staff and shall maintain documentation regarding each employee’s assessed competency.

(8) APPROVAL OF DEMENTIA TRAINING CURRICULUM. All dementia care training provided to direct care staff must be approved by a private or non-profit organization that is approved by the Department through a ""Request for Application"" (RFA) process.

This Rule is not met as evidenced by:

The findings of the kitchen inspection, conducted 04/29/24, 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.
The findings of the revisit to the kitchen inspection of 04/29/24, conducted 07/17/24, 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 maintain the kitchen in good repair and in a sanitary manner in accordance with Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: Observation of the facility kitchen was reviewed on 04/29/24 from 11:30 am through 2:45 pm and the following was noted: a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, and/or black matter was visible on or underneath the following: * Outside freezer interior; and* Kitchen flooring.b. The following areas were in need of repair: * Gaps in wall by electrical outlet under sink; and * Small hole in pantry wall by floor.c. Staff 3 (Cook/Person in charge) was not able to correctly identify cook to temperatures for ground meats, proper reheat temperatures, or identify illnesses needing exclusion and reporting. Staff 2 (House Manager) was not able to correctly identify illnesses needing exclusion and reporting.d. Multiple items in reach in refrigerators did not contain open and/or use by dates. One item (potato salad) was found past the manufactures use by date. e. Differing meat/proteins were found in same pan defrosting creating the potential for the thawing fluids from each meat product to potentially contaminate the other. These proteins had different cook to temperature requirements. The pan these items were thawing in was also too small for the products creating the potential for thawing fluids to contaminate other areas of the refrigerator.f. The facility had two sinks in the kitchen, neither was designated for a handwashing sink. Both sinks had dirty dishes in them, Staff 3 was observed to wash their hands in the sink where dirty dishes were located. There was no dedicated sink for handwashing throughout the duration of the kitchen survey. Facilities must designate a hand washing sink that was not used for other purposes while utilized as a hand washing sink.g. During the tour, the facility was not sanitizing dishes. Staff 3 stated the items s/he used for cooking were washed and rinsed by hand then air dried. They acknowledged there was no sanitize step. Residential dishwasher being used had a light display to identify when dishes were "clean" and when they were "sanitized". Upon entry to kitchen the cycle of dishes was finished and the light for "clean" was activated and no light was on for "sanitized". Staff 3 validated that the fastest cycle was used for the dishwasher that usually took one hour. Staff 2 and Staff 3 were not able to identify how they could validate the dishes were sanitized. After consulting the manufactures manual, the manual indicated the light would illuminate if the rinse cycle met the sanitized requirements. The stipulation was that the hot water inlet to dish washer needed to reach at least 120 degrees Fahrenheit and the sanitize selection made for the cycle. Facility staff were not aware of this process to ensure dishes were effectively sanitized. Surveyor and Staff 2 validated water source closest to dish washer did reach at least 120 degrees so that per the manufacture would be able to sanitize the dishes when the correct cycle was selected. The sanitize cycle would add 60 min to the regular cycle length so that the quick 60 min cycle would not "sanitize" the dishes. Staff 1 (Administrator/Owner) and Staff 2 stated they would ensure the correct cycle was used for washing dishes to include the extra sanitizing cycle time.h. Multiple disposable delivery service items (spoons/forks/straws) were not stored covered or inverted as required to protect from potential contamination. i. Surface sanitizing solution was tested utilizing strips from the facility. The concentration was well over the reading ppm for Quat solution. The effective and desired range for Quat sanitation is between 200-400 ppm. Upon review of dilution of the chemical used staff were under diluting the product producing a much stronger solution. Staff were not testing the solution with the strips to ensure the liquid was at the correct ppm for effective sanitation of surfaces. Over concentration of chemical can be potentially harmful if ingested. j. Care staff were observed serving and assisting residents with their meals without aprons on to protect residents' meals from potential contamination from care giving tasks.k. Multiple bulk dry good bins were noted to have scoops stored inside the food product potentially contaminating the food product. Staff 1, 2, and 3 toured the kitchen areas with the surveyor and acknowledged identified areas needing attention.

The findings of the re-licensure survey, conducted 05/23/22 through 05/25/22, 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 for Home and Community Based Services Regulations.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 first re-visit to the re-licensure survey of 05/25/22, conducted 11/01/22 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 and OARs 411 Division 004 Home and Community Based Services Regulations.

Based on observation and interview, it was determined the facility failed to ensure all required postings were displayed in a conspicuous location for residents and visitors and available for inspection at all times. Findings include, but are not limited to: During a tour of the environment on 08/23/22, there were no postings related to the administrator or designee in charge or the current facility staffing plan. The findings were reviewed with Staff 1 (Administrator) on 08/23/22. He acknowledged the findings.

Based on observation and interview, the facility failed to ensure reasonable precautions were exercised against any condition that could threaten the health, safety, or welfare of residents. Findings include, but are not limited to: During a tour of the laundry room on 05/23/22, Staff 7 (MT) reported staff rinsed soiled linens and clothing in the utility sink before laundering.The laundry room was toured with Staff 1 (Administrator) on 05/23/22 and 05/24/22. He reported the facility did not have a process for disinfecting the sink following each use. The need to ensure reasonable precautions were exercised against any condition that could threaten the health, safety, or welfare of residents was discussed with Staff 1. He acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure that all incidents of abuse, suspected abuse, and injuries of unknown cause were thoroughly investigated to rule out abuse for 2 of 2 sampled residents (#s 2 and 4) whose facility records were reviewed. Findings include, but are not limited to: 1. Resident 4 was admitted to the facility in 02/2022 with diagnoses including cerebral infarction. Review of the resident's 02/15/22 through 05/23/22 progress notes revealed the resident experienced the following: * 05/07/22 - Blister on right ankle; and* 05/19/22 - Wound on left pinky toe. There was no documented evidence the facility investigated the blister on Resident 4's right ankle after it was discovered on 05/07/22. Review of an investigation dated 05/18/22, related to the wound on Resident 4's pinky toe, revealed the facility did not rule out abuse and failed to address the following required elements: * Time and place of the incident;* Follow-up action, including measures taken to prevent future reoccurrence to the resident; and* Administrator's review, including signature and date of review.The need to promptly and thoroughly investigate incidents of abuse, suspected abuse, and injuries of unknown cause was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.
2. Resident 2 was admitted to the facility in 02/2021 with diagnoses including cerebral palsy and chronic pain.The resident's facility record was reviewed, including progress notes dated 02/22/22 through 05/23/22 and an incident report dated 05/23/22, and interviews with staff and the resident were conducted.On 05/20/22, Resident 2 experienced an unwitnessed fall while transferring from his/her wheelchair to the toilet. An incident report was completed on 05/23/22. The facility investigation of the fall did not include the following elements:* Time, date, place, and individuals present;* Description of the event as reported;* Response of staff at the time of the event, including measures taken to immediately protect the safety of the resident;* Follow-up action, including measures taken to prevent future reoccurrence to the resident; and* Administrator's review, including signature and date of review.The need for a timely and thorough investigation of all incidents of abuse or suspected abuse was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure the kitchen was clean and in good repair and food preparation procedures were in accordance with the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to:The kitchen was toured on 05/23/22 at 10:55 am, and the following was identified to be in need of cleaning and/or repair:* A burner knob on the stove was loose and came off easily;* The paint was chipping off cabinet doors and drawer fronts, exposing bare wood;* Cabinet door handles and drawer knobs were sticky;* There was food debris in the small drawer to the right of the stove;* The paint was wearing off the dry storage shelves, exposing bare wood;* The floor in front of the dry storage shelves had a build-up of brownish-gray matter; and* The kitchen door did not close unless it was physically lifted by the doorknob to fit into the door frame.Staff 5 (Chef) reported he used soap and water, then a disinfectant spray to clean the kitchen countertops/food prep areas and stated they did not have test strips.Areas needing cleaning and/or repair were shown to and discussed with Staff 1 (Administrator) at 2:30 p.m. on 05/23/22.The need to use specific cleaning products, such as Quaternary or bleach, along with test strips, to clean kitchen countertops/food prep areas, along with test strips, was discussed with Staff 1 on 05/24/22 at 10:10 a.m. He indicated he would purchase an appropriate chemical the same day.At 5:05 p.m. on 05/24/22 the tray line was observed, and it was discovered staff were not taking temperatures of the food before it was served. The need to temp food prior to serving was discussed with Staff 1 and Staff 2 (Assistant Administrator) on 05/24/22 at 5:10 pm.The need to follow the Food Sanitation Rules was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure new move-in evaluations addressed all required elements for 2 of 2 sampled residents (#s 1 and 4) whose facility records were reviewed. Findings include, but are not limited to: Review of the new move-in evaluations for Resident 1 (admitted 05/2022) and Resident 4 (admitted 02/2022) revealed the facility failed to address multiple required elements. The need to ensure new move-in evaluations addressed all required elements was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure an RN significant change of condition assessment was completed in a timely manner for 1 of 1 sampled resident (#4) who experienced a significant change of condition. Findings include, but are not limited to: Resident 4 was admitted to the facility in 02/2022 with diagnoses including cerebral infarction. Review of the resident's 02/15/22 through 05/23/22 progress notes, outside provider notes, and RN assessments revealed the following: 02/25/22: Staff progress notes indicated the resident had a "pressure ulcer...small wound...open";02/28/22: The home health PT noted the resident had a bandage on his/her sacrum;03/01/22: The home health RN assessed the wound as a Stage 2 pressure ulcer; 03/04/22: A progress not written by the RN indicated she did not assess the resident's sacrum that day, as s/he had gone to the emergency department for an unrelated condition; 02/25/22 - 03/11/22: There were multiple staff entries in the progress notes related to "pressure ulcer monitoring"; and03/11/22: The facility RN completed an assessment of the wound. During an interview with Staff 2 (Assistant Administrator) and Staff 4 (RN) on 05/24/22, Staff 4 reported she could only complete an assessment if she knew about the condition. The need to ensure an RN significant change of condition assessment was completed in a timely manner was discussed with Staff 1 (Administrator), Staff 2, Staff 3 (Manager), and Staff 4. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure the physician or other practitioner was notified when a resident refused to consent to a medication or treatment order for 1 of 1 sampled resident (#4) who had documented refusals of medication. Findings include, but are not limited to: Resident 4 was admitted to the facility in 02/2022 with diagnoses including cerebral infarction. Review of the resident's current physician orders and 05/01/22 through 05/23/22 MAR revealed the resident had refused administration of a nicotine patch on multiple occasions, for which there was no notification of the physician. The need to ensure the physician or other practitioner was notified when a resident refused to consent to a medication or treatment order was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

2. Resident 4 was admitted to the facility in 02/2022 with diagnoses including cerebral infarction. Review of the resident's 05/01/22 through 05/23/22 MAR and current physician orders revealed the resident had PRN orders for both acetaminophen and hydrocodone for pain. There were no resident-specific parameters on the MAR which instructed unlicensed staff which medication to administer first. The need to ensure MARs were accurate and included medication-specific parameters for PRN medications was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.
Based on interview and record review, it was determined the facility failed to ensure MARs were accurate and included medication-specific parameters for PRN medications for 2 of 2 sampled residents (#s 2 and 4) whose MARs were reviewed. Findings include, but are not limited to:1. Resident 2's 05/01/22 through 05/23/22 MAR was reviewed and revealed multiple PRN pain and asthma medications lacked resident-specific parameters, and there were duplicate orders for Mylanta (an antacid) and Pepto Bismal (an antinausea medication).The need to ensure MARs were accurate and included clear parameters for PRN medications was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN). They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure PRN psychotropic medications had written, resident-specific parameters and non-pharmaceutical interventions to attempt prior to administering the medication for 1 of 1 sampled resident (#3) who was prescribed and used PRN psychotropic medication. Findings include, but are not limited to:Resident 3 was admitted to hospice services in 01/2022 with diagnoses including congestive heart failure.Hospice prescribed lorazepam 0.5 mg every four hours as needed for anxiety or shortness of breath. The MAR lacked instruction related to non-pharmacological interventions for staff to attempt prior to administration of the medication and failed to identify how the resident's anxiety was displayed.Resident 3 was administered PRN lorazepam on 05/08/22, 05/11/22, and 05/15/22. There was no documentation which indicated why the medication had been administered or that non-pharmacological interventions had been attempted without success prior to administration.There was no documented evidence hospice had instructed staff to administer the PRN psychotropic medication without attempting non-pharmacological interventions first. The need to ensure the MAR included a description of how the resident exhibited anxiety and non-pharmacological interventions to attempt prior to administering the PRN psychotropic medication was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/23/22. They acknowledged the findings.

Based on observation, interview and record review, it was determined the facility failed to ensure supportive devices with potentially restraining qualities were assessed, including a thorough review by an RN, PT or OT prior to use, instruction to caregivers on the correct use and precautions of the device were provided, and use of the device was included in the resident's service plan for 1 of 1 sampled resident (#4) who used a tilt-in-space wheelchair. Findings include, but are not limited to: Resident 4 was admitted to the facility in 02/2022 with diagnoses including cerebral infarction. A tilt-in-space wheelchair was observed in the resident's room on 05/24/22. The controls for adjusting the position of the chair were located behind the seat where the resident would be unable to reach them. During an interview with the resident on 05/25/22, s/he confirmed that s/he must ask staff for assistance to adjust the chair. The need to ensure supportive devices with potentially restraining qualities were assessed, including a thorough review by an RN, PT or OT prior to use, instruction to caregivers on the correct use and precautions of the device were provided, and use of the device included in the resident's service plan was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN). They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure 2 of 4 newly hired staff (#s 8 and 9) completed pre-service orientation and dementia training in the required timeframe. Findings include, but are not limited to:Staff training records were reviewed on 05/24/22 and revealed the following:1. Staff 8 (CG), hired 03/03/22, completed pre-service dementia training on 05/25/22, which was after she began providing care to residents.2. Staff 9 (Activity Director/Chef), hired 04/20/22, failed to sign her job description prior to performing any job duties.The need to ensure all pre-service orientation and dementia training was completed in the specific timeframes was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure 2 of 2 long-term staff (#s 3 and 6) completed a minimum of six hours of dementia care in-service training annually. Findings include, but are not limited to:Staff training records were reviewed on 05/24/22.There was no documented evidence Staff 3 (Manager), hired 01/23/19, and Staff 6 (CG), hired 03/16/12, completed a minimum of six hours of dementia care annually.The need to complete all required annual training in a timely manner was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3, and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure life safety instruction was provided to staff on alternate months as required by the Oregon Fire Code (OFC). Findings include, but are not limited to:Fire and life safety records were reviewed on 05/25/22.There was no documented evidence the facility provided fire and life safety training instruction to staff on alternating months from fire drills.The need to provide staff fire and life safety training on alternate months was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure residents were instructed on fire and life safety procedures within 24 hours of admission and annually. Findings include, but are not limited to:Fire and life safety records were reviewed on 05/25/22 and revealed a lack of documented evidence related to the following required elements:* Instruction to residents on fire and life safety procedures within 24 hours of admission.* A written record, including content and residents attending, of annual instruction to residents on general safety procedures, evacuation methods, responsibilities during fire drills, and designated meeting places inside or outside the building in the event of an actual fire.The need to ensure residents were provided instruction per the Oregon Fire Code was discussed with Staff 1 (Administrator), Staff 2 (Assistant Administrator), Staff 3 (Manager), and Staff 4 (RN) on 05/25/22. They acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure the exterior environment was maintained in good repair. Findings include, but are not limited to:During a tour of the courtyard on 05/23/22, the following tripping hazards were observed: * There were two cracks in the concrete patio which created an uneven surface; and* Multiple drop-offs of two to three inches were noted along edges of the patio.The need to ensure the environment was maintained in good repair to prevent potential tripping hazards was discussed with Staff 1 (Administrator ) on 05/23/22. He acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure the interior of the building was maintained clean and in good repair. Findings include, but are not limited to: During a tour of the environment on 05/23/22, the following were identified: * There were multiple chips in the laminate flooring;* There were raised transition moldings in the flooring which presented a tripping hazard for residents; and * There were stains on multiple dining room chairs. The findings were reviewed with Staff 1 (Administrator) on 05/23/22 and 05/25/22. He acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure washing machines had a minimum rinse temperature of 140 degrees Fahrenheit unless a chemical disinfectant was used. Findings include, but are not limited to: A survey of the laundry room on 05/23/22 revealed the facility used residential washing machines which did not indicate the rinse temperature and laundry detergent which lacked a chemical disinfectant. The environment was toured with Staff 1 (Administrator) on 05/23/22. He acknowledged the findings.