Magnolia Gardens Memory Care

Residential Care Facility
1355 DAUGHERTY AVE, COTTAGE GROVE, OR 97424

Facility Information

Facility ID 50R314
Status Active
County Lane
Licensed Beds 35
Phone 5419428966
Administrator JOSE GARCIA-GUTIERREZ
Active Date Apr 4, 2003
Owner Cottage Grove Sl, LLC
2735 12TH ST SE, STE 100
SALEM OR 97302
Funding Medicaid
Services:

No special services listed

10
Total Surveys
15
Total Deficiencies
0
Abuse Violations
10
Licensing Violations
2
Notices

Violations

Licensing: 00395747-AP-346435A
Licensing: 00395747-AP-346435B
Licensing: 00357275-AP-307611
Licensing: OR0005268200
Licensing: 00314759-AP-267074
Licensing: OR0004635000
Licensing: 00250649-AP-206454
Licensing: OR0003956300
Licensing: OR0003956301
Licensing: OR0003956302

Notices

CALMS - 00028851: Failed to provide safe environment
OR0005277801: Failed to meet the scheduled and unscheduled needs of residents

Survey History

Survey 1IML

3 Deficiencies
Date: 8/13/2024
Type: Complaint Investig., Licensure Complaint

Citations: 3

Citation #1: C0260 - Service Plan: General

Visit History:
1 Visit: 8/13/2024 | Not Corrected

Citation #2: C0300 - Systems: Medications and Treatments

Visit History:
1 Visit: 8/13/2024 | Not Corrected

Citation #3: C0360 - Staffing Requirements and Training: Staffing

Visit History:
1 Visit: 8/13/2024 | Not Corrected

Survey PYZB

0 Deficiencies
Date: 3/22/2024
Type: State Licensure, Other

Citations: 1

Citation #1: C0000 - Comment

Visit History:
1 Visit: 3/22/2024 | Not Corrected
Inspection Findings:
The findings of the kitchen inspection, conducted 03/22/24, 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.

Survey 04WK

2 Deficiencies
Date: 12/7/2023
Type: Complaint Investig., Licensure Complaint

Citations: 2

Citation #1: C0151 - Facility Administration: Criminal History

Visit History:
1 Visit: 12/7/2023 | Not Corrected
Inspection Findings:
The findings of the on-site investigation, conducted 12/07/23 are documented in this report. The investigation was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities. Abbreviations possibly used in this document:ADL: activities of daily livingCBG: capillary blood glucose or blood sugar CG: caregiverCS: Compliance Specialistcm: centimeterED: Executive DirectorF: FahrenheitHH: Home HealthLPN: Licensed Practical NurseMT: Medication TechMAR: Medication Administration RecordMCC: Memory Care CommunityOT: Occupational TherapistPT: Physical TherapistPRN: as neededRCC: Resident Care CoordinatorRN: Registered Nurse

Citation #2: C0303 - Systems: Treatment Orders

Visit History:
1 Visit: 12/7/2023 | Not Corrected
Inspection Findings:
The findings of the on-site investigation, conducted 12/07/23, are documented in this report. The investigation was conducted to determine compliance with the OARs 411 Division 54 for Residential Care and Assisted Living Facilities, OARs 411 Division 57 for Memory Care Communities. Abbreviations possibly used in this document:ADL: activities of daily livingCBG: capillary blood glucose or blood sugar CG: caregiverCS: Compliance Specialistcm: centimeterED: Executive DirectorF: FahrenheitHH: Home HealthLPN: Licensed Practical NurseMT: Medication TechMAR: Medication Administration RecordMCC: Memory Care CommunityOT: Occupational TherapistPT: Physical TherapistPRN: as neededRCC: Resident Care CoordinatorRN: Registered Nurse

Survey 04NC

2 Deficiencies
Date: 5/24/2023
Type: State Licensure, Other

Citations: 3

Citation #1: C0000 - Comment

Visit History:
1 Visit: 5/24/2023 | Not Corrected
2 Visit: 8/22/2023 | Not Corrected
Inspection Findings:
The findings of the kitchen inspection, conducted 5/24/23, 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 05/24/23, conducted 08/22/23, 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.

Citation #2: C0240 - Resident Services Meals, Food Sanitation Rule

Visit History:
1 Visit: 5/24/2023 | Not Corrected
2 Visit: 8/22/2023 | Corrected: 7/23/2023
Inspection Findings:
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, and to ensure meals were served at appropriate temperatures and were palatable, in accordance with the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to:Observation of the memory care "Servery" on 05/24/23 at 11:15 am through 2:30 pm revealed the following:a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, black matter and grease was visible on or underneath the following:* Exterior and interior of range/oven;* Interior of refrigerator and freezer;* Interior of cupboards and drawers;* Utility carts;* Floors in corners, edges and under equipment;* Area behind sink;* Interior and exterior of microwave;* Tops of both reach in refrigerators/freezers;* Coffee maker machine; and* Sponge/scratcher used to clean dishes with visible dried food debris.b. The following areas were found in need of repair:* Caulking around countertops with dirt and possible mold accumulation;* Area under sink near counter top with mold accumulation;c. Cups of ice cream in freezer were stored uncovered. Item in refrigerator found without cover and no date or label. d. Clean rags used for cleaning and sanitizing surfaces were observed stored under sink next to plunger and chemicals and were not protected from potential contamination.e. Dishwashing rack was found stored on the floor. f. There were no strips to monitor the concentration of the dishwasher chemical used to sanitize dishes to ensure effective sanitation.g. Ice machine found with visible mold build up on interior of ice machine. h. Temperatures of food items received from main kitchen were not at required 135 degrees Fahrenheit for hot foods or 40 degrees or under for cold. Staff heated plates in microwave but temperatures did not reach required 165 degrees for reheating as required. Staff were unaware of reheat temperature requirements and served food items under the required temperature requirements. Chicken was reheated to 162.4. A large bowl of macaroni salad was delivered to the servery on top of the hot cart and sat there until ready for service. Temperature was 50 degrees. Staff placed in refrigerator for approximately 10 minutes before platting and serving. Staff did not recheck temperature to see if it had reached the required 40 degrees or lower needed for service. Meal temperature logs were reviewed and revealed multiple entries for the month of May where temperatures were not meeting requirement and no documented follow up to the identified food items under the required temperatures. Staff was interviewed and indicated they would heat the food to above the 135 before service. Records reviewed found 18 food items in May that were documented under the 135 degrees required without documented indication of what action was taken to ensure appropriate temperatures were reached prior to service to residents. There were also multiple missing temperatures for multiple days. i. Staff were observed to wash hands in a sink where dishes were stored for cleaning. Staff did not have a designated area to wash hands. Staff were observed to not wash hands as required when switching tasks, going from dirty to clean, and touching potentially contaminated items. Multiple staff were observed handling the mouth contact and food contact portion of straws with their bare hands that were potentially contaminated from touching door knobs, handles etc. j. Staff were not sanitizing thermometer in between checking temperatures of food items. Staff was observed to "rinse" thermometer under water and wipe with paper towel. k. Clean dishes stored in hallway not protected from potential contamination.In an interview, Staff 2 (Dining Service Manager) acknowledged the identified areas needing addressed. Records of temperatures from main kitchen revealed temperatures were appropriate when food items left the main kitchen. Staff 2 indicated that the hot cart may not be holding appropriate temperatures causing food temps to drop under desired/required levels. Staff 2 verified staff should be reheating the food items to 165 or above if found under 135. Staff 2 verified macaroni salads and other cold items should immediately be placed in the refrigerator until right before service in order to maintain appropriate temperatures. Staff 1 (Executive Director) and the surveyor reviewed the areas in need of cleaning, repair and incorrect practices. S/he acknowledged areas of concern.

Citation #3: Z0142 - Administration Compliance

Visit History:
1 Visit: 5/24/2023 | Not Corrected
2 Visit: 8/22/2023 | Corrected: 7/23/2023
Inspection Findings:
Based on observation, record review, 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.

Survey O04K

3 Deficiencies
Date: 1/10/2023
Type: Complaint Investig., Licensure Complaint

Citations: 4

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 1/10/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 01/10/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0150 - Facility Administration: Operation

Visit History:
1 Visit: 1/10/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 01/10/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #3: C0160 - Reasonable Precautions

Visit History:
1 Visit: 1/10/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 01/10/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #4: C0302 - Systems: Tracking Control Substances

Visit History:
1 Visit: 1/10/2023 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 01/10/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Survey UFUY

1 Deficiencies
Date: 12/5/2022
Type: Complaint Investig.

Citations: 2

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 12/5/2022 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 12/05/2022. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0361 - Acuity-Based Staffing Tool

Visit History:
1 Visit: 12/5/2022 | Not Corrected
Inspection Findings:
Based on record review and interview, it was confirmed that the facility failed to fully implement and update an acuity-based staffing tool (ABST). Findings include:Compliance Specialist (CS) reviewed the Uniform Disclosure Statement (UDS) that reflects Shift Hours 6am-2pm Direct Care Staff 3 Medication Aid 1, 2pm-10pm Direct Care Staff 3 Medication Aid 1 and 10pm-6am Direct Care Staff 1 Medication Aid 1. CS reviewed the staff schedule for the month of December 2022. On 12/05/22 S1 stated current census was 31. CS reviewed ABST for 12/05/22 which shows the following: ABST reflects that not all residents are currently entered into tool. ABST reflects AM/day shift includes 30 residents (AM total care hours 24.23 and require a total of 4 caregivers/med-techs), PM/evening shift 29 (PM total care hours 21.8 and require a total of 3 caregivers/med-techs) and Graveyard shift 30 (Graveyard total care hours 8.92 and require a total of 2 caregivers/med-techs) out of current census 31 that require assistance with all activities of daily living (ADL) scheduled and unscheduled care needs. Current Resident Roster includes 32 residents in the facility. ABST does not represent or included all 22 ADL's for scheduled and unscheduled daily care needs for each of the 30 residents entered into tool. Review of residents #1-3 service plans (SP) reflects that not all residents' care needs are reflected in ABST acuity, therefore staffing hours are not calculated to reflect current resident care needs. R3's SP shows resident is on a complex medication regime for daily medication management; also requires follow up interventions after receiving medication for side effects daily. R3's SP reflects resident is bladder incontinent and requires extensive care daily. The above care mentioned is not reflected in ABST and is listed as PRN for daily required scheduled care needs. In separate interviews with Staff #1 (S1), they stated they had been working hard to get all resident entered into system. They stated at quarterly review, staff is entering all ADL's for residents in ABST. S1 stated they cannot just remove ADLs from the service plans or the Acuity Based Staffing Tool (ABST) unless there is an evaluation done. The nurse or the administrator can only make changes by completing an evaluation in the Blue Step program. The evaluation or change in service would then carry over to the service plan and then be updated in the ABST. On 12/05/22, these findings were reviewed with and acknowledged by S1.

Survey CB5J

1 Deficiencies
Date: 10/11/2022
Type: Complaint Investig., Licensure Complaint

Citations: 1

Citation #1: C0361 - Acuity-Based Staffing Tool

Visit History:
1 Visit: 10/11/2022 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 10/11/2022. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Survey Q6ND

1 Deficiencies
Date: 7/14/2022
Type: Complaint Investig., Licensure Complaint

Citations: 2

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 7/14/2022 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 7/14/2022. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0303 - Systems: Treatment Orders

Visit History:
1 Visit: 7/14/2022 | Not Corrected

Survey GKSG

1 Deficiencies
Date: 7/7/2022
Type: Complaint Investig., Licensure Complaint

Citations: 2

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 7/7/2022 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 7/7/2022. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0361 - Acuity-Based Staffing Tool

Visit History:
1 Visit: 7/7/2022 | Not Corrected
Inspection Findings:
Based on interview, observation and record review, it was confirmed that the facility failed to fully implement and update an acuity-based staffing tool (ABST). Findings include:Review of staffing schedules for June and July 2022, posted staffing plan, ABST summary, and service plan for Resident #1. The ABST shows the facility needs 5 caregivers (CG) and 1 med tech (MT) for Days and Swing shift, and 1 CG and 1 MT for NOC shift. The posted staffing plan shows that they have 2.5 CG and 1 MT for Days and Swing shifts, and 1 CG and 1 MT for NOC shift. CS observed that the facility is staffed below their staffing as reported on the ABST on 07/07/22. The posted staffing plan has not been updated with the current staffing levels from the ABST.The above information was shared with Staff #1 on 07/07/22, who acknowledged the findings.In an interview on 07/07/22, Staff #1 stated that the facility is using their own ABST. It pulls information (for the required ADLs) straight from the service plans to determine their acuity and staffing levels. They are not currently staffing to the new staffing levels as they do not have the staff to do so. They are currently hiring and are in the process of training new staff. Resident #1 missed their scheduled appointment due to the facility not getting them ready on time.Plan of Correction: The facility is hiring more staff and currently training new hires, they will staff per the ABST and update the posted staffing plan, and hope to have a specific person for showers, transportation, and coordinating appointments when fully staffed.

Survey P61W

1 Deficiencies
Date: 7/7/2022
Type: Complaint Investig., Licensure Complaint

Citations: 2

Citation #1: C0010 - Licensing Complaint Investigation

Visit History:
1 Visit: 7/11/2022 | Not Corrected
Inspection Findings:
Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 07/07/2022. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Citation #2: C0360 - Staffing Requirements and Training: Staffing

Visit History:
1 Visit: 7/11/2022 | Not Corrected
Inspection Findings:
Based on interview and record review, it was confirmed that the facility failed to have enough staff to meet the scheduled and unscheduled needs of the residents. Findings include:Review of staffing schedules for June and July 2022, posted staffing plan, Acuity Based Staffing Tool (ABST), service plans and progress notes for Resident #1, and the appointment calendar. The facility is not staffing per the ABST.Interviews on 07/07/22, Staff #1 stated that the facility is using their own ABST. They are not currently staffed per their acuity. They are in the process of hiring and training staff. Currently the admin assistant is the person scheduling appointments and setting up transportation for residents. The resident missed their first appointment because ride source cancelled, and they had to reschedule because their maintenance director was off that day, and they don ' t have anyone else that can drive the bus. The second appointment was missed because the resident was not ready to go on time. They had to reschedule the appointment. Staff should be assisting the residents and making sure they are ready for their appointments.Plan of Correction:Hiring and training new staff, staffing per the ABST and updating the posted staffing plan. They would like to have a specific person for showers, transportation, and appointments when they are fully staffed.