Gateway Gardens

C240This Rule is not met as evidenced by: Based on observation, interview, and record review, 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:(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: Reach in freezer door ice and water dispensers in 184 and 194; Kitchen floor in 154; Microwave in 154; Range top in 194; and Fan cages and blades in windows of houses 184 and 194.1. We have invested in specialized straw cleaners to clean the ice and water dispensers efficiently. Additionally, all kitchen floors, microwaves, and range tops underwent an immediate deep cleaning to eliminate debris, and fans have been removed from kitchen areas. These actions have markedly improved the cleanliness of the specified locations.2. We've instituted a rigorous regimen in which the nocturnal shift is tasked with comprehensive deep cleaning duties every night. The responsible staff members must complete and sign off on these tasks to ensure adherence to our cleaning standards.3. To maintain oversight of the cleaning process, we will collect and review the deep cleaning task lists monthly. The Kitchen Coordinator has also introduced a monthly audit system to verify that all tasks meet our cleanliness standards.4. The responsibility for overseeing the completion of deep cleaning and monthly audits has been assigned to the Gateway Gardens Kitchen Coordinator and the Administration Team. They will also conduct daily inspections to monitor and ensure the ongoing cleanliness of our kitchen facilities. (b) The following areas were in need of repair: Reach in thermometers in house 184and 194 not operational; Reach in refrigerator in house 154 at 50 degrees Fahrenheit; and Multiple cupboards found with integrity damage causing nonsmooth surfaces for effective cleaning and sanitizing.1. The Kitchen Coordinator promptly replaced all non-functional thermometers. Additionally, the Maintenance Team repaired all cupboards with integrity damage to ensure smooth surfaces that can be effectively cleaned and sanitized.2. We have implemented a protocol for daily temperature checks. All cooks must immediately report any malfunctioning fridge thermometers to the Administration Team, ensuring swift replacement to maintain optimal temperatures.3. The Kitchen Coordinator, in collaboration with the Maintenance Team, has incorporated an additional checklist item in the monthly audits specifically to inspect cupboards for any nonsmooth surfaces or structural damage, ensuring ongoing maintenance and cleanliness.4. The Kitchen Coordinator is tasked with promptly collecting and completing all audit reports. The Administration Team oversees these audits' timely completion and accuracy, further ensuring compliance with health regulations. This oversight will ensure consistent adherence to maintenance and cleanliness standards throughout the facility.(c) Multiple containers of strawberries were found with visible mold growth in the cook shack's walk-in cooler.1. All affected strawberry containers were promptly discarded. To prevent future occurrences, we have communicated with Sysco regarding the substandard quality of the delivered fruit.2. We have instituted daily checks by our Cooks to identify any signs of mold on produce. They are also tasked with thoroughly inspecting all deliveries from Sysco and reporting any issues immediately.3. As an extension of the procedure mentioned in the previous point, the Cooks and the Kitchen Coordinator will conduct daily inspections of all produce to ensure its freshness and safety.4. The Kitchen Coordinator is specifically tasked with maintaining the integrity of our produce supply, ensuring all fruits and vegetables are free from mold and of the highest quality upon receipt.(d) Refrigerator in house 154 was found at 50 degrees, Food items were temped and also were above required 41 degrees Fahrenheit. Milk was at 53 degrees, and egg salad was at 44 degrees. Temp logs were reviewed, and no refrigerator temperatures were documented on 4/16/24 or 4/17/24 to indicate potentially how long food items were out of temp. Staff 2 (Head Cook/Person in Charge) acknowledged that food items needed to be discarded from that fridge and that food needed to be stored at 41 degrees or below.1. We immediately discarded all perishable items from the affected refrigerator. The thermometer was replaced, and the Maintenance Team conducted a thorough inspection, confirming no further issues with the appliance.2. We are enhancing our oversight of daily refrigerator temperature logs. Any readings above 41 degrees Fahrenheit must be reported directly to the Kitchen Coordinator and the Administration Team to ensure immediate corrective action.3. The Kitchen Coordinator conducts monthly audits that now include reviewing daily temperature logs to verify completeness and compliance with safety standards. This proactive measure ensures consistent adherence to required temperature controls.4. The Kitchen Coordinator is assigned the responsibility of consistently monitoring temperature logs and ensuring all food items are stored within safe temperature ranges. The Administration Team oversees these audits' timely completion and accuracy, further ensuring compliance with health regulations.(e) Regular shell eggs were observed stored in all cottage refrigerators. Staff in house 194 were interviewed and validated eggs were cooked to order for residents in the morning, including poached and over medium or over easy eggs (yolks runny) if desired by residents. Staff were not able to verbalize the correct temperatures for eggs and breakfast meats. When asked if they check the temperature of breakfast items they stated no as they were "just warming up items that were already previously cooked." These staff members did not know what pasteurized shell eggs looked like or if they utilized them.1. All unpasteurized eggs have been replaced with pasteurized eggs across all kitchens. Staff have undergone training on the correct cooking temperatures for eggs and breakfast meats and on identifying the difference between pasteurized and unpasteurized eggs to enhance food safety.2. the Kitchen Coordinator will ensure that only pasteurized eggs are ordered for use. Educational flyers displaying safe cooking temperatures for various foods have been strategically placed in all kitchens, serving as a quick reference for staff to ensure compliance with food safety guidelines.3. The Kitchen Coordinator will include checks on the presence and condition of food temperature flyers in their monthly audits. Additionally, the Administration Team initiated a 'Question of the Day' focusing on food service temperatures to reinforce knowledge and ensure staff awareness.4. The Kitchen Coordinator is responsible for procuring pasteurized eggs and maintaining visible and accessible food temperature guidelines in the kitchens. The Administration Team will provide oversight to verify that these standards are consistently met and adhered to by all kitchen staff.(f) There was no system in place for the internal workings of water and ice dispensers to ensure they were cleaned and sanitized. The maintenance staff had a process for ensuring filters werechanged per manufacturers' specifications. The water and ice dispensers in all homes were noted to have white and black debris built up on them. Staff 2 acknowledged the need for enhanced cleaning of dispensers.1. The Kitchen Coordinator immediately deep-cleaned and sanitized each refrigerator's water and ice dispensers. To improve the cleaning process's efficacy, specialized straw cleaners were procured and utilized specifically for this purpose.2. The Kitchen Coordinator has established a new monthly deep-clean task to ensure the thorough and appropriate cleaning of the water and ice spouts on each refrigerator and ice dispenser.3. The Kitchen Coordinator has incorporated the cleaning of water and ice dispensers into the monthly deep cleaning task list and audit reports. Additionally, through random walkabouts, the Kitchen Coordinator will conduct spot inspections of these dispensers to verify the effectiveness of the cleaning procedures.4. The Kitchen Coordinator is responsible for the timely collection and completion of all audit reports. The Administration Team will oversee these activities, ensuring audits are conducted on schedule and meet our stringent health and safety standards. This structured oversight guarantees ongoing compliance with maintenance and cleanliness protocols across all facilities.(g) Staff 2 was not able to correctly identify illnesses that would need to be excluded and reported to the local health department, as required under the Person in Charge's responsibilities in Oregon food sanitation rules.1. The Kitchen Coordinator proactively undertook training to correctly identify illnesses and symptoms that are reportable to the local health department. She has effectively shared this crucial information with the rest of the kitchen staff to ensure compliance with Oregon food sanitation rules.2. The Chief Operations Officer has developed a comprehensive Gastrointestinal Policy and Procedure, detailed in the corrective actions section C295. This policy educates all staff on recognizing symptoms in themselves and residents, the proper protocol for reporting these to the infection control specialist, and the risk of an outbreak.3. The Kitchen Coordinator, in collaboration with the Chief Operations Officer, who also serves as the Infection Control Specialist, will conduct annual reviews of the policy and procedures to ensure they remain current and effective in meeting health and safety standards.4. The Kitchen Coordinator and the Administration Team are jointly responsible for staying updated on any changes to policies and procedures. They are tasked with ensuring that these updates are communicated clearly and effectively to all staff members, maintaining a well-informed team that adheres to health regulations.

C295This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to have policy and procedures in place for exclusion of food service workers when sick or ill with potential or actual contagious food-related illness. Findings include, but are not limited by:At 1:15 pm, staff 2 (Person in Charge) was interviewed and was not able to correctly identify illness and symptoms that would require exclusion from working in the kitchen or would need to be reported to the Local Health Department per Food Sanitation Rule requirement.1. In response to the identified gaps, the Chief Operations Officer, who also serves as the Infection Control Specialist, has developed a comprehensive Gastrointestinal Illness Policy and Procedure. This policy aligns with Oregon Administrative Rules (OAR) 411-054-0050(1-5) on Infection Prevention & Control, ensuring strict adherence to health regulations.2. To maintain the highest standards of health and safety, the Kitchen Coordinator will collaborate with the Chief Operations Officer to review our exclusion of food service workers when sick or ill and update policies and procedures annually. This will ensure our practices are up-to-date and continue to meet regulatory requirements effectively.3. We will conduct a thorough annual audit of our illness policy and procedures. This audit is designed to verify compliance with all relevant laws and regulations, thus safeguarding our staff and the individuals we serve from health risks associated with food handling.4. The Kitchen Coordinator and the Administration Team share the responsibility for continuously monitoring updates to health policies and procedures. They will ensure all updates are promptly communicated and implemented across our team, guaranteeing compliance and promoting a culture of health and safety excellence.

Z142This Rule is not met, as evidenced by: Based on observation, interview and record review, it was determined that the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to: Refer to C 240 and C 295.Please refer to our C240 and C295 submissions above.

1- In response to C231, we have two residents and multiple examples based on not completing a complete and prompt investigation to rule out abuse or neglect. The action described below will be taken to correct the rule violation for each example and resident. Gateway Gardens Administration Team will do a full review of our Nursing Department's Policies and Procedures regarding Special Incident Reports (SIR's) and OAR 411-054-0028 to fully understand the law and better understand the requirement for prompt investigation of injuries of unknown cause, resident-to-resident altercations, and elopement are investigated to rule out abuse or neglect and the appropriate authorities are notified. 2- Our Administration Team will review the Nursing Department's Policies and Procedures regarding SIR's and OAR 411-054-0028, specifically OAR 411-54-0028 (2)(a-d) & (3) with the Nursing Department's Nurses and Resident Care Managers (RCM) to ensure they fully understand when to investigate and the importance of investigating potential abuse or neglect. During our next Direct Staff Monthly Mandatory Meeting for continuing education, we will review our Medpassing Manual's Procedures regarding Incident Reporting and OAR 411-54-0028 (2)(a-d) to refresh and remind all staff, specifically our Medpassers, the importance of reporting all injuries of unknown cause during their assessments. 3- While preparing for our quarterly Resident Care Conferences, the Nursing Department and the Administration Team will review all chart notes in preparation for the conference to ensure no incidents were overlooked and not investigated appropriately. 4- Gateway Gardens Administration team will be responsible for seeing that all corrections are completed. The Administration Team and the Nursing Department will be responsible for monitoring SIR's and chart notes to ensure all injuries of unknown cause, suspicion of abuse, or neglect are reported appropriately.

1- Gateway Gardens Activity Director created an In-House Activity Calendar and provided supplies for the listed activities. 2- The Activity Department added a weekly task to include reviewing the In-House Activity Calendar, ensuring supplies are provided, and updating the calendar as needed. 3- Our Activity Director will use feedback from residents to make any requested changes to the In-House Activity program and audit the calendar and supplies weekly. 4- Gateway Gardens Activity Director will be responsible for ensuring the corrections are completed and monitored weekly.

1- In response to C252, we have two examples of not ensuring move-in evaluations address all required elements and are completed before the resident is admitted. The action described below will be taken to correct the rule violation for each example.Gateway Gardens Evaluators will review OAR 411-054-034 (1-6) to ensure all move-in evaluations address all required elements and complete the assessment before the resident is admitted to Gateway Gardens. Making a specific note not to use N/A anywhere on the evaluation, and if the resident, family, or others cannot answer the questions, it will be documented with the response given. 2- The Evaluators, Administration Team, and the Nursing Department, which includes RCM's, will review OAR 411-054-034 (1-6) as stated in number 1 above. This will provide redundancy as well as a check and balances within our admission procedures. 3- The RCM will review all evaluations while they enter the data from the evaluation into our Electronic Medical Administration Record (EMAR) to ensure the evaluation is completed in its entirety prior to the resident's admission. 4- Our check and balance will be the responsibility of both the Evaluator and the RCM. The Evaluator will verify that the evaluation is completed in its entirety before sending it to the Nursing Department for admission. The RCM will verify that the evaluation is complete while entering the resident's information into our EMAR. If there are any errors, the RCM will return the evaluation to the Evaluator for completion.

Example #11- Resident's Service Plan was updated to reflect that this resident is independent with smoking, and they can keep their cigarettes and lighter on their person and lock both in a drawer in their room. Gateway Garden's RN will do a smoking/safety assessment quarterly during Quarterly Care Conferences or as needed due to any decline in resident's mentation.Example #21- Resident's Service Plan was updated to reflect increased call light usage, transfer status, and side rail usage. Precautions related to the use of side rails were added to their Service Plan. Example #31- Resident's Service Plan was updated with usage and precautions related to side rail usage.Example #41- Resident's Service Plan was completely redone to reflect Verbal aggression towards individual residents; Excessive pacing, statements of leaving and attempts to climb the exterior fence; Jumping or climbing over the kitchen gate, increased hunger and food-seeking; Actual elopement from the secured courtyard and attempts to leave through the front door; Chronic pain, non-drug interventions and effect on behaviors; Climbing out their bedroom window to the courtyard and safety interventions; and Interventions and activities to engage the resident and when to utilize for agitation.Examples #1-42- Staff was notified of all Service Plan changes, and education was provided to report all Service Plan changes or requests on a new section of their Caregiver worksheet designed for communication with the Nursing Department and educated about our universal guidelines and precautions related to residents with side rails.Examples #1-43- The Nursing Department and Administration Team will audit Service Plans during our Quarterly Care Conferences or as needed. Examples #1-44- The Nursing Department, which includes our RCM, will complete any updates to Service Plans as needed, and our Administration Team will monitor the workflow to verify that all Service Plans are current and reflect each resident appropriately.

1- A fax was sent on 07/27/2023 to document Resident 3's July medication refusals with a request for how often they would like to be notified. Hospice's replied with specific instructions that are recorded on our EMAR and procedures. 2- Gateway Gardens revised its Physician Orders (PO) template to include the medication refusal requests section, which is currently being used. 3- The Nursing Department will conduct a monthly audit of resident medication refusals and communication with their Primary Care Physicians (PCP) to ensure we meet OAR 411-054-055(1)(k). 4- The Nursing Department, specifically the RCM, has completed the correction and will monitor medication refusals and communications going forward.

1- Non-pharmacological interventions were added to our medication delivery system within our EMAR for Resident 3's psychotropic PRN's. As well as an audit of all resident psychotropic PRN's to ensure there are non-pharmacological interventions meeting OAR 411-054-0055 (6).2- The Nursing Department added a check and balance to their workflow when adding psychotropic medications to our EMAR System. 3- The Nursing Department and Administration Team will audit psychotropic PRN's to ensure there are non-pharmacological interventions listed during our Quarterly Care Conferences. The RCM will review any medication changes or as needed.4- The Nursing Department, specifically the RCM, has completed the correction and will monitor all residents' psychotropic PRN use with non-pharmacological use going forward.

1- In response to C361, we have four resident examples of not ensuring the ABST is updated to reflect resident care needs accurately. The action described below will be taken to correct the rule violation for each example and resident.The RCM contacted the ABST Team, who provided education and direction for better accuracy to reflect resident care needs. RCM then applied what was learned to Gateway Gardens ABST for better accuracy with staffing calculations. 2- With the education our RCM received from the ABST Team, we now have the appropriate knowledge to enter resident care timeframes into the ABST tool correctly. This education will be applied to all new residents and if any current residents' needs change. 3- The ABST will be updated with any Service Plan change, 30-day service plan updates, and during our Quarterly Care Conferences. 4- The Nursing Department, specifically the RCM, has completed the corrections and will monitor resident needs and update the ABST as needed.

Refer to C231, C242 and C361

Refer to C252, C260, C305 and C330

1- Gateway Gardens Maintenance personnel immediately began taking measures to increase the fence height to six feet (or 72 inches) in height. Our fencing is now current with OAR 411-057-0170 (5) (b). 2- Our Maintenance Division added checking the height of our fencing to their quarterly walk-through and checks. 3- Our Maintenance Division has a standing quarterly walk-through and checks. As stated above, fence height has been added to their task list. 4- The Administration Team and Maintenance personnel will monitor and correct any fencing in accordance with OAR 411-57-0170 (5) (b).