Brookstone Alzheimer's Special Care Center

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 main facility kitchen and the North and South unit kitchenettes on 11/22/24 from 10:00 am thru 1:55 pm and revealed the following deficient practices.

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:

* Walk in cooler ceiling;
* Wall above walk in cooler entrance;
* North Unit dining room cupboards/drawers;
* Industrial can opener housing;
* Attached knife sharpener;
* Ceiling vents;

b. The following areas needed repair:

* Caulking in ware washing area with black matter debris buildup.
* Caulking behind hand washing sink with black matter buildup and pieces of caulking missing.
* Multiple areas on kitchen floor with cracked or missing tile pieces.
* Large piece of tile missing in threshold between walk in cooler and freezer.
* Industrial slicer with protective coating pealing/chipped and exposing non smooth surfaces.
* Plastic stripping along tile near floor cracked/missing chunks.
* Water damage to cupboard under sink in North dining room.
* Microwave in South unit dining room with damage to ceiling and door opener.
* Cabinet shelving in kitchen and in dining rooms with sections of porous wood exposed yielding uncleanable surfaces.
* Small handheld can opener with rust on blade.

c. Facility did not have correct test strips for surface sanitizer. Facility had chlorine test strips for Quaternary sanitizer. Kitchen staff were not able to correctly verbalize correct sanitation concentrations for surface sanitizing.

d. Pureed main entrée for lunch (Meatballs in gravy) was not at correct texture. There were observed chunks of meat and was too thin. Surveyor utilized the fork test and the gravy portion of the entree dripped thru the tines. Kitchen staff were about to serve pureed residents, however surveyors intervened and requested further processing to ensure entrée was smooth and thicker for proper texture. Surveyors reviewed spoon flick and fork tine test for puree textures to ensure safe textures for residents with puree diets.

e. Cook observed to handle ready to eat food items (tater tots/rolls) with gloves that had been used for other tasks potentially contaminating the ready to eat items.

f. Person in charge (Staff 2 Food Service Director) was unable to correctly describe proper cooling processes and 3 compartment sanitation processes. They were also unable to correctly identify food worker illness and exclusion protocols as outlined in Food code.

At 1:30 pm, Staff 1 (Administrator) and Staff 2, were informed of the concerns found and they acknowledged the need for correction.

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 observations and interviews, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:

Refer to C240.

OAR 411-057-0140(2) Administration Compliance

(2) The licensee of a memory care community must comply with both the licensing rules for the facility and Chapter 411, Division 57.

This Rule is not met as evidenced by:

The findings of the relicensure survey, conducted 05/06/24 through 05/08/24, 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, OARs 411 Division 57 for Memory Care Communities, and OARs 411 Division 004 Home and Community Based Services Regulations.Tag numbers beginning with the letter C refer to the Residential Care and Assisted Living rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.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 05/08/24, conducted 07/23/24 through 07/24/24, 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 57 for Memory Care Communities.

Based on observation, interview, and record review, it was determined the facility failed to ensure service plans were reflective of the resident's needs, provided clear direction to staff regarding the delivery of services, and were implemented for 1 of 2 newly admitted sampled residents (# 5), whose service plans were reviewed. Findings include, but are not limited to: Resident 5 was admitted to the facility in 05/2024 with diagnoses including dementia with behavioral disturbance, chronic urinary tract infections and was receiving hospice services. Observations of the resident and interviews with staff were conducted throughout the survey. The resident's current service plan, dated 05/02/24, facility progress notes from and outside provider visit notes from 05/02/24 through 05/06/24 were reviewed.The resident's service plan was not reflective, did not include clear instruction for staff, and/or was not implemented in the following areas:* Hospice services including the tasks they were responsible to provide and how to contact the hospice provider;* Elevation of hands on pillows for edema;* Reclining wheelchair with pressure reducing air cushion;* Meal assistance;* Continuous Positive Airway pressure (CPAP) machine use and instructions;* Oxygen use and instructions;* Foley catheter instructions for care and monitoring;* Interventions for sexual behaviors;* Pushing of fluids throughout each day;* Air mattress on bed;* Turning and repositioning in bed;* Pain;* Assistance needed to participate in activities; and* Emergency evacuation assistance.The need to ensure service plans were reflective of the resident's needs and preferences, provided clear direction regarding the delivery of services, and services were implemented and was discussed with Staff 1 (Administrator), Staff 2 (Health Services Director/LPN) and Staff 3 (RCC) on 05/08/24. They acknowledged the findings.

Based on observation, interview, and record review, it was determined the facility failed to update the acuity-based staffing tool (ABST) to accurately reflect all the ADLs for each resident, including the amount of staff time needed to provide care for 5 of 5 sampled residents (#s 1, 2, 3, 4 and 5). Findings include, but not limited to:Interviews with staff, observations of the residents, review of current service plans, and progress notes were completed. The facility ABST showed numerous ADL care areas which were not reflective of the sampled residents' current care needs. The number of staffing minutes noted on the ABST did not accurately reflect the amount of time staff spent with residents providing care. The need to ensure all time needed for providing ADL care to residents was accurate in the ABST tool was reviewed with Staff 1 (Administrator) on 04/07/24, and Staff 1, Staff 2 (Health Services Director/LPN) and Staff 3 (RCC) 04/08/24. The staff acknowledged the findings. No additional information was provided.

Concerns were identified in the following areas and the facility was provided with technical assistance:H 1517: Individual Privacy: Own Unit. OAR 411-004-0020(2)(d): (d) Each individual has privacy in his or her own unit.

Concerns were identified in the following areas and the facility was provided with technical assistance:(e) Units must have entrance doors lockable by the individual, with the individual and only appropriate staff having a key to access the unit.

Concerns were identified in the following areas and the facility was provided with technical assistance:H 1580: Limitations: Threats to health and safety. OAR 411-004-0020(2)(d) to (2)(j): Ensure the residential setting applies individually based limitations when conditions may not be met due to threats to the health and safety of an individual or others.

Based on observation, interview, and record review, it was determined the facility failed to provide non-health care services in accordance with the licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:Refer to C 361.

Based on observation, interview, and record review, it was determined the facility failed to provide health care services in accordance with the licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:Refer to C 260.

Based on observation, interview, and record review, it was determined the facility failed to document individualized activity plans for 4 of 4 sampled residents (#s 1, 2, 3, and 4) whose evaluations and service plans were reviewed. Findings include, but are not limited to:Observations and interviews were completed between 05/06/24 and 05/08/24. Service plans and evaluations were reviewed for Residents 1, 2, 3, and 4. The following were identified:Review of the "Social, Spiritual and Recreational Activities" section of the service plans and also the "Resident Interest Chart" for the sampled residents showed the evaluations were lacking one more of the following components:* Current abilities and skills;* Emotional and social needs and patterns;* Physical abilities and limitations;* Adaptations necessary for the resident to participate; and* Activities for behavior interventions.There was no documented evidence that individualized activity plans were developed based on the residents' activity evaluation.The need to ensure the facility evaluated each of the required components and developed individualized activity plans based on the evaluation for each resident was discussed with Staff 1 (Administrator) and Staff 3 (RCC) on 05/08/24. They acknowledged the findings.

The findings of the on-site investigation conducted 07/20/2023 and 07/13/2023 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

The findings of the kitchen inspection, conducted on 01/18/23, 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 revisit to the kitchen inspection of 1/18/23, conducted 4/11/23, 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.

Based on observation and interview, it was determined the facility failed to ensure the kitchen was clean and in good repair, in accordance with the Food Sanitation Rules 333-150-0000. Findings include, but are not limited to: On 01/18/23 at 10:30 am, the kitchen was observed to need cleaning and repair in the following areas: * Dust/grease buildup on wall and piping above the stove; * Vents above the toaster and steam table had buildup of dust/grease; and* Lights in dry food storage area did not have covers on them. The areas which required cleaning and repair were observed and discussed with Staff 1 (Food Service Director) on 01/18/23. The findings were acknowledged.

Based on observation and interview, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to: Refer to C 240.

The findings of the re-licensure survey conducted 05/24/21 through 05/26/21 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, OARs 411 Division 57 for Memory Care Communities and OARs 411 Division 004 Home and Community Based Services Regulations.Tag numbers beginning with the letter C refer to the Residential Care and Assisted Living rules. Tag numbers beginning with the letter Z refer to the Memory Care Community rules.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
The findings of the 1st revisit to the re-licensure survey of 5/26/21, conducted 8/11/21 through 8/12/21 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, OARs 411 Division 57 for Memory Care Communities 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, was being followed and provided clear caregiving instructions for 1 of 4 sampled residents (#3) whose service plan was reviewed. Findings include, but are not limited to:Resident 3 was admitted to the facility in February 2018 with diagnosis including dementia. The resident's service plan, dated 1/20/21 and Change in Plan of Care documents were reviewed. Resident 3's care and room were observed during the survey.The resident's service plan was not reflective, not followed or lacked clear caregiving instructions in the following areas: * Beverage preferences;* Yogurt given at each meal;* Sensory alarm use and placement; * Number of nutritional supplements given with meals and medication passes;* Devices used for transfers;* Ability to self propel in a manual wheelchair and ambulate with staff; and * Pressure relieving cushion used in the resident's wheelchair. An interview with Staff 1 (Administrator) and Staff 2 (Health Services Director) on 5/26/21 at 12:25 pm confirmed the service plan had been updated but was not available to staff. The failure to ensure service plans were accurate, included caregiving instructions and were being followed was discussed with Staff 1 and Staff 2 who acknowledged the findings.

Based on observation, interview and record review, it was determined the facility failed to provide health care services in accordance with the licensing rules for Residential Care and Assisted Living Facilities. Findings include, but are not limited to:Refer to C 260.

2. Resident 3 was admitted to the memory care community in February 2018 with diagnoses including dementia. The resident's service plan, Activity Preferences and Life Story documentation were reviewed. a. Resident 3's activity evaluation failed to address the following required elements:* Current interests; * Current abilities and skills; * Emotional and social needs and patterns; * Physical abilities and limitations; and* Adaptations necessary for the resident to participate. b. On 5/26/21 at 10:21 am, a music activity was observed in the dining room. Resident 3 was sitting in a different common area on a recliner. Staff 15 (CG) took the resident to his/her room to provide care and returned Resident 3 to the common area where s/he was previously. The resident's service plan was reflective of him/her enjoying music activities, being hard of hearing and directed staff to invite and encourage activity participation. On 5/26/21, the need for an individualized activity plan to be reflective of the resident's current status and was being followed by staff was discussed with Staff 1 (Administrator) and Staff 2 (Health Services Director) who acknowledged the findings.
Based on observation, interview and record review it was determined the facility failed to develop individualized activity plans based on evaluation and reflective of residents' current preferences and needs for 2 of 4 sampled residents (#s 1 and 3) whose records were reviewed. Findings include, but are not limited to:1. Resident 1 was admitted to the memory care community in September 2015 with diagnoses including dementia and insomnia. Review of the resident's evaluation, dated 5/14/21 and service plan, dated 5/21/21 indicated the following:a. Resident 1's service plan lacked an individualized plan for meaningful activities that promoted the physical and emotional well-being of the resident, were person-directed and available during the resident's waking hours.b. Resident 1's activity evaluation failed to address the following required elements:* Past and current interests;* Current abilities and skills;* Emotional and social needs and patterns;* Physical abilities and limitations;* Adaptations necessary for the resident to participate; and* Activities for behavior interventions.On 5/26/21 the lack of an individualized activity plan that was reflective of the resident's current status, addressed all required components and available during the resident's waking hours was discussed with Staff 1 (Administrator) and Staff 2 (Health Services Director). They acknowledged the findings.