Brookstone Alzheimer's Special Care Center

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).

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.

A. Walk in cooler ceiling/wall cleaned, and ceiling vents dusted / cleaned. Cupboards and drawers cleaned. Can opener knife sharpener peice removed on 11/25 by Food Service Director. B. Premium NW scheduled to recaulk areas, replace cracked / broken / chipped tiles, remove plastic stripping, repair water damage, and to resurface porous wood. Industrial slicer to be resurfaced. Microwave gotten rid of (11/23) Small handheld can opener thrown away (11/23). C. Test strips purchased (direction provided / inservice completed 11/23) as well as premade sanitizer purchased. D. Diet consistancy training provided / inservice done 12/10 by National Director of Culinary Services. E. Tongs / utensils used to serve all food items (culinary director spot checking daily) F. Education provided on proper cooling processes (by National Director of Culinary Services) and three compartment sanitation processes. 1. Repairs and training were provided to correct violations 2. Environmental walkthroughs will be done by dietary and / or manager weekly to ensure thing are in good repair and in regulatory compliance. 3. Environmental walkthroughs will be done weekly. 4. Food Service Director and Executive Director will be responsible to see that corrections are completed and monitored.

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).

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.

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.

Refer to above 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.

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.

C 260 1. Care plan was updated with specific instructions. (Resident # 5) 2. HSD, RCC, and ED will ensure that specific clear instructions are outlined in resident care plans. Including Hospice / outside provider services what tasks we are to provide and how to contact the hospice provider. Service plans will reflect residents needs and preferences and will provide clear direction of services. 3. This will be evaluated for each resident prior to admit, 30 days, quartely, and with any change. 4. HSD, RCC, and ED will be responsible to see that corrections are completed and monitored.

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.

C 361 1. ABST has been updated to include items discussed upon exit. Not only for Residents #1, 2, 3, 4, and 5 but for all residents. 2. ABST had been being updated with input from direct care staff. We have created an ABST team that will include input from staff in various positions. 3. HSD, RCC, and ED will ensure that ABST is reflective of each residents need in all elements on ABST prior to admit, 30 days, quarterly, and with any significant change. 4. HSD, RCC, and ED will be responsible to see that corrections are completed and monitored.

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.

Z 142 Please 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.

Z 162 Please 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.

Z 164 1. Program Director created resident activity care plans that are acessible by all staff. This was completed not just for residents # 1, 2, 3, and 4 but for all residents. 2. HSD, RCC, and Program Director will colaborate to ensure that not only interests are listed in the care plan but that the following will be reflective as well; 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. 3. This will be evaluated prior to admit, 30 days, quarterly, and with any changes. 4. HSD, RCC, and Program Director are responsible to see that the corrections are completed and monitored.

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 living bid: twice a day CBG: capillary blood glucose or blood sugar CG: caregiver cm: centimeter ED: Executive Director F: Fahrenheit HH: Home Health LPN: Licensed Practical Nurse MA:          Medication Aide MAR: Medication Administration Record MCC: Memory Care Community mg: milligram ml: milliliter MT: Medication Technician OT: Occupational Therapist PT: Physical Therapist PRN: as needed qd: every day or daily qid: four times a day QI:     quality improvement RCC:       Resident Care Coordinator RN:     Registered Nurse TAR:     Treatment Administration Record tid:           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.

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 living CBG: capillary blood glucose or blood sugar CG: caregiver CS: Compliance Specialist cm: centimeter ED: Executive Director F: Fahrenheit HH: Home Health LPN: Licensed Practical Nurse MT:                        Medication Tech MAR: Medication Administration Record MCC: Memory Care Community OT: Occupational Therapist PT: Physical Therapist PRN: as needed RCC: Resident Care Coordinator RN: Registered Nurse

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.

C 240 * Dust / grease buildup on wall and piping above the stove was professionally cleaned within days of survey visit and will be on a quarterly cleaning schedule (and as needed). * Dust / grease buildup on the vents above the toaster and steam table were taken down and cleaned. Will be on a cleaning rotation. * Light covers in the store room were put on and will remain in place. Food Service Director will add items to kitchen cleaning tool and will audit with Administrator to ensure plan of correction continues to be followed.

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.

Z 142 * Please refer to C 240 above

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.