Brookdale Roseburg

Residential Care Facility
3400 NW EDENBOWER BLVD, ROSEBURG, OR 97470

Facility Information

Facility ID 5MA254
Status Active
County Douglas
Licensed Beds 60
Phone 5414645600
Administrator SARAH CALVERT
Active Date Sep 7, 2000
Owner Emeritus Corporation

Funding Medicaid
Services:

No special services listed

6
Total Surveys
17
Total Deficiencies
0
Abuse Violations
10
Licensing Violations
0
Notices

Violations

Licensing: CALMS - 00082857
Licensing: CALMS - 00082858
Licensing: CALMS - 00082958
Licensing: OR0003959000
Licensing: OR0001845900
Licensing: OR0001845902
Licensing: SR19342
Licensing: RS187941
Licensing: RS186764
Licensing: RS171365

Survey History

Survey KIT004497

2 Deficiencies
Date: 5/19/2025
Type: Kitchen

Citations: 2

Citation #1: C0240 - Resident Services Meals, Food Sanitation Rule

Visit History:
t Visit: 5/19/2025 | Not Corrected
1 Visit: 6/17/2025 | Not Corrected
Regulation:
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).
Inspection Findings:
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 kitchen and dining room kitchenette areas on 05/19/25 from 11:00 am through 1:30 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:

* Kitchen drains
* Interior of microwaves in main kitchen and all unit kitchenettes
* Interior of unit ovens
* Interior of reach in freezers in units
* Industrial can opener housing
* Floors under worktables
* Stainless steel shelving holding pans
* Stainless steel shelving by spices/binders
* Box fan cage and blades near prep space
* Exterior of convection oven and steamer
* Fan cages in walk in cooler
* Griddle top open grease reservoir area
* Outside food storage area floor/shelves and canned goods with accumulation of dust/dirt/debris.

b. Kitchen staff observed handling/preparing food and/or clean dishes without hair effectively restrained.

c. Food observed stored in walk in cooler uncovered and exposed to potential contamination. Dry baked goods observed stored in baking rack in kitchen with food products open and exposed to potential contamination.

d. Multiple potentially hazardous food items were noted stored in walk in cooler and/or reach in cooler that were not dated when opened. Multiple food items were found past the manufactures use by dates in unit refrigerators.

e. Staff member in Saphire unit was observed reheating resident food in microwave. Staff was not able to correctly state proper reheat temperatures. Cook and Designated Person In Charge was also not able to correctly identify the proper reheat temperature.

f. Refrigerator for holding resident food in Saphire unit did not contain a thermometer to ensure resident food was held at appropriate cold food temperatures.

g. Care staff was observed entering kitchen area and did not wash hands or restrain hair upon entering.

h. Multiple rags for surface cleaning/sanitation were observed stored out of the sanitation buckets on random counters/areas throughout the kitchen.

i. Staff 2 was not able to correctly review proper cooling process to handle leftovers. The facility was observed to have a large number of leftovers in the refrigerators. The facility did not have an effective process to ensure food was properly cooled to ensure safe.

Staff 2 Cook/PIC, toured kitchen with surveyor and acknowledged the areas identified. At approximately 1:30 pm, the surveyor and Staff 1 (Business Office Manager/Facility Designee) and Staff 3 (Health and Wellness Director) reviewed areas of concern. Staff 1 and 3 acknowledged the above areas needed to be cleaned and practices that needed addressed.

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:
Plan of Correction:
1) All areas of the kitchen including, but not limitied to, areas specified in the statement of deficiencies were cleaned at time of survey and then will be deep cleaned by all kitchen staff by compliance date and maintained by community staff following community cleaning schedule.
New thermometer props ordered for each kitchenette
Staff inserviced on cleanliness and dating and covering foods, and proper temperatures, per state regulations on 5/23/25.

2) Daily cleaning schedule is in place for neighborhood kitchenettes and for main kitchen and will be reviewed weekly.
3) Kitchen cleanliness will be monitored on a weekly basis. Food preperation will be monitored on a weekly basis.

4) The Executive Director, Dining Services Manager, and or designee will be responsible for monitoring continuned compliance.

Citation #2: Z0142 - Administration Compliance

Visit History:
t Visit: 5/19/2025 | Not Corrected
1 Visit: 6/17/2025 | Not Corrected
Regulation:
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.
Inspection Findings:
: 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:
Plan of Correction:
See above.

Survey NPKH

2 Deficiencies
Date: 4/22/2025
Type: Complaint Investig., Licensure Complaint

Citations: 2

Citation #1: C0360 - Staffing Requirements and Training: Staffing

Visit History:
1 Visit: 4/22/2025 | Not Corrected

Citation #2: C0363 - Acuity Based Staffing Tool - Updates & Plan

Visit History:
1 Visit: 4/22/2025 | Not Corrected

Survey LX58

1 Deficiencies
Date: 6/24/2024
Type: Validation, Re-Licensure

Citations: 2

Citation #1: C0000 - Comment

Visit History:
1 Visit: 6/26/2024 | Not Corrected
Inspection Findings:
The findings of the re-licensure survey, conducted 06/24/24 through 06/26/24, 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, OARs 411 Division 57 for Memory Care Communities. Technical assistance was provided for Home and Community Based Services Regulations OARs 411 Division 004.

Citation #2: H1517 - Individual Privacy: Own Unit

Visit History:
1 Visit: 6/26/2024 | Not Corrected
Inspection Findings:
Concerns were identified and the facility was provided with technical assistance in the following areas:H 1517: OAR 411-004-0020(2)(d): Individual Privacy: Own Unit (d) Each individual has privacy in his or her own unit. This was regarding no lock on the apartment side of the door to shared bathrooms.

Survey HY2Q

0 Deficiencies
Date: 6/6/2024
Type: State Licensure, Other

Citations: 1

Citation #1: C0000 - Comment

Visit History:
1 Visit: 6/6/2024 | Not Corrected
Inspection Findings:
The findings of the kitchen inspection, conducted 06/06/24, 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 BC2Z

3 Deficiencies
Date: 4/4/2023
Type: State Licensure, Other

Citations: 4

Citation #1: C0000 - Comment

Visit History:
1 Visit: 4/4/2023 | Not Corrected
2 Visit: 7/7/2023 | Not Corrected
Inspection Findings:
The findings of the kitchen inspection, conducted 4/4/23, 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 re-visit to the re-licensure kitchen inspection of 04/04/23, conducted on 07/07/23, 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: 4/4/2023 | Not Corrected
2 Visit: 7/7/2023 | Corrected: 6/1/2023
Inspection Findings:
Based on observation, record review and interview, it was determined the facility failed to ensure the kitchen was maintained in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to:Observations of the main facility kitchen food storage areas, food preparation, and food service on 4/4/23 revealed splatters, spills, drips, dust and debris noted on: - Can opener blade and casing; - Interior and exterior of microwave; - Industrial mixer; - Exterior of grill, stove, ovens, sides of equipment, knobs and handles; - Grease trap of grill with large dirt/grease build up; - Floors throughout kitchen area, under/between equipment/shelves; - Floors under racks in walk in cooler; - Fan cages and ceiling of walk in; - Box fans in dish room and prep area; - Walls throughout kitchen area; - Plastic shelving storing dry goods in main kitchen area; - Baking rack; - Open shelving; and - Vents and fire sprinklers. The following items/areas in the main kitchen were in need of repair: - Metal racks storing dishes heavily rusted; - Wood shelving storing dishes with exposed pressed wood; - Hand washing sink with active leak causing standing water underneath; and - Steamer with active leak causing standing water underneath equipment.* Multiple items stored in freezer were not labeled/dated when opened or removed from original packaging. * Dishwashing racks were observed stored on the floor.* Desserts for noon meal were transported to units uncovered.At approximately 1:30 pm, Staff 2 (Dining Director) and the Surveyor toured the kitchen. Staff 2 acknowledged the above findings.Observations of the unit kitchenette food storage areas, food preparation, and food service revealed splatters, spills, drips, dust and debris noted on/in: - Interior and exterior of drawers and cupboards; - Interiors of microwaves; - Interiors of ovens; - Entry latches/doors to kitchenette area; and - Freezers.* Plastic cups/mugs were noted to be ready to serve resident drinks that had stains and scoring.* Dishware was noted to be put away wet leaving noticeable water residue in the cups and in the cupboard.* Scoops were observed stored in bulk coffee containers.* Trash cans did not have lids for when not in use.* Thermometer probes were not small diameter for thin foods and/or were not operating correctly.* Staff were observed to touch ready to eat foods (buttered bread) with potentially contaminated gloves.* Plates/dishes of food from prior meals stored in unit refrigerator with no labels or dates.* Bulk foods (cereal/chips/etc) not securely closed after use.At 2:45 pm the areas in need of cleaning, repair and attention were reviewed with Staff 1 (Executive Director). She acknowledged the findings.
Plan of Correction:
1) All areas of the kitchen including, but not limitied to, areas specified in the statement of deficiencies were cleated at time of survey and then will be deep cleaned by all kitchen staff by compliance date and maintained by community staff following community cleaning schedule. New metal racks were ordered and will be in place prior to complaince date. New thermometer props ordered for each kitchenette. Staff inserviced on cleanliness and dating and covering foods, per state regulations. 2) Daily cleaning schedule is in place for neighborhood kitchenettes and for main kitchen and will be reviewed weekly. 3) Kitchen cleanliness will be monitored on a weekly basis. Food preperation will be monitored on a weekly basis.4) The Executive Director, Dining Services Manager, and or designee will be responsible for monitoring continuned compliance.

Citation #3: Z0142 - Administration Compliance

Visit History:
1 Visit: 4/4/2023 | Not Corrected
2 Visit: 7/7/2023 | Corrected: 6/1/2023
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.
Plan of Correction:
Refer to deficiencieces C240 and POC.

Citation #4: Z0155 - Staff Training Requirements

Visit History:
1 Visit: 4/4/2023 | Not Corrected
2 Visit: 7/7/2023 | Corrected: 6/1/2023
Inspection Findings:
Based on record review and interview, it was determined the facility failed to ensure 13 of 27 staff reviewed who prepare and serve food had active food handlers certificates. Findings include but are not limited to:On 4/4/23 at approximately 1:30 pm, surveyor reviewed employee records for active food handlers cards. There were 8 employees who did not have a food handlers card on file and 4 that were found to be expired. At 2 pm, Staff 1 (Executive director) verified there were multiple staff that did not have active food handlers certification. Staff 1 verified that those staff duties did include preparing and serving food to residents.
Plan of Correction:
1) All staff whose duties include preparing and servicng food to residents, with expired or no food handlers cards will go through training and records will be up to date, with food handlers cards. 2)Training binders will be audited monthly to ensure all staff have up to date food handlers cards and all new staff will obtain during training. 3) Monthly and at new hire. 4) The Executive Director, Business Office Manager and or designee will be responsible for monitoring continued compliance.

Survey BJLD

9 Deficiencies
Date: 4/12/2021
Type: Validation, Re-Licensure

Citations: 10

Citation #1: C0000 - Comment

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Not Corrected
4 Visit: 1/21/2022 | Not Corrected
5 Visit: 8/9/2022 | Not Corrected
Inspection Findings:
The findings of the relicensure survey conducted 4/12/21 through 4/14/21 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 C refer to the Residential Care and Assisted Living Facilities 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 first re-visit to the re-licensure survey of 4/12/21 through 4/14/21, conducted 9/7/21 through 9/8/21, 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 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 second revisit to the re-licensure survey of 04/14/2021, conducted on 11/17/2021, 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, Division 57 for Memory Care Communities and Home and Community Based Services Regulations OARs 411 Division 004.Re-visit found not in compliance.Tag numbers beginning with C refer to the Residential Care and Assisted Living Facilities 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 third re-visit to the re-licensure survey of 04/14/2021, conducted 01/21/2022, 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 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 fourth re-visit to the re-licensure survey of 04/14/21, conducted 08/09/22, 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 57 for Memory Care Communities.

Citation #2: C0270 - Change of Condition and Monitoring

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Corrected: 11/17/2021
Inspection Findings:
Based on interview and record review, it was determined the facility failed to monitor and document weekly progress of short-term changes of condition until the condition resolved for 1 of 4 sampled residents (#3) whose records were reviewed. Resident 3 had a yeast infection that worsened over time. Findings include, but are not limited to: Resident 3 was admitted to the facility 6/2020 with diagnoses including dementia and a history of colon cancer. During the entrance conference, 4/12/21, Resident 3 was identified as having a foley catheter and colostomy.Resident 3's 4/8/21 service plan instructed staff to provide "peri-care" and catheter care twice a shift. The service plan included detailed instructions on how staff were to provide peri-care, including how to position the resident, which direction to wipe to clean the area, what type of cloth to use and the position of the foley catheter tubing during care. A review of resident's clinical record, including service plan, progress notes, Home Health notes, MARs and temporary service plans indicated the following:On 1/15/21 Staff 2 (RN) documented the Home Health nurse noted "increased vaginal discharge that smelt yeasty, recommended to start Nystatin cream [topical used to treat skin infections] and request Diflucan [antibiotic]".The January 1st through 31st, 2021 MAR showed 1 dose of Diflucan 150 mg was administered on 1/19/21. On 2/4/21 staff documented "[Resident] has a yeast rash in [his/her] groin and vaginal area, have started Nystatin cream per MD order". There was no documented evidence the previously noted yeast infection had resolved, the yeast infection originally noted had been monitored for improvement or worsening of the infection, or if the medication used to treat the infection had been effective. Staff further documented: * On 2/5/21 resident refused application of the Nystatin cream;* On 2/15/21 resident "refused to stand" for application of cream; and * On 2/16/21 "resident was in beauty salon" so Nystatin cream was not applied. A note from the Home Health RN, 2/11/21 described a "strong yeast odor noted. Labia is red, swollen and very sensitive to touch making [catheter] changes difficult". A follow up note, written 2/17/21, by Staff 2 indicated she needed to "follow up on Diflucan".The February 1st through 28th, 2021 MAR showed 1 dose of Diflucan 150 mg was administered on 2/23/21. On 3/8/21 staff documented "Rash on groin is very raw and was bleeding". No further documentation regarding the yeast infection was made in the residents' record until 3/23/21 when staff wrote "yeast rash on peri area and breast looked a lot better. Not raw or very red." There was no previous mention of a yeast rash under the resident's breast and no monitoring of the condition documented in the resident's chart. A summary note, written by Staff 2 on 3/24/21, stated during a catheter change on 3/23/21, the Home Health nurse observed a "large amount of drainage from peri-area, education provided by [Staff 2] to caregiving staff that [Resident] is to have peri-care and catheter care twice shift routinely". Staff documented on 3/24/21 "Yeast rash looks clean and not so raw. No redness under the breasts". On 4/13/21, Staff 15 (CG) assigned to work with Resident 3 on day shift, stated she emptied resident's catheter bag "several times during the day", but was unsure if she had noticed a yeast infection under the residents breasts or groin area. Staff 11 (MT) stated she did not apply the Nystatin powder on her shift, so was unaware of the infection. There was no documented evidence the facility consistently monitored the resident's perineum yeast infection, evaluated interventions used to treat the infection for effectiveness, or considered new interventions to address the issue between 1/15/21 and 4/12/21 at the time of survey. This resulted in the condition worsening over time. The need to ensure short term changes of condition were monitored, weekly progress noted, and interventions were reviewed and evaluated for effectiveness was discussed with Staff 1 (Executive Director) and Staff 2 on 4/13/21 and 4/14/21. They acknowledged the findings.
Based on observation, interview and record review, it was determined the facility failed to determine what actions and interventions were needed for 2 of 2 sampled residents (#6 and 7) when they experienced short-term changes of condition and failed to communicate the actions and interventions to staff on each shift; failed to evaluate 1 of 2 sampled resident (#7) who experienced a significant change of condition, refer to the facility RN, document the change and update the service; and failed to monitor changes of condition through resolution. Resident 7 experienced significant weight loss and gain. This is a repeat citation. Findings include, but are not limited to:1. Resident 7 was admitted to the facility in February 2020 with chronic kidney disease. Review of Resident 7's 6/13/21- 9/7/21 progress notes, service plans, temporary service plans, physician orders and communications and weight records revealed the following: a. Resident 7's documented weight went from 155 lbs on 6/18/21 to 147.2 on 7/21/21. This constituted a 5.03% weight loss in one month which was significant. Resident 7 was hospitalized from 7/28/21 for a right total hip replacement and returned to the facility on 8/1/21. His/her documented weight was 148 lbs on 8/2/21. An 8/11/21 RN assessment related to the 7/21/21 significant weight loss was documented in the progress notes. The RN stated, "No further interventions indicated at this time as the weight is stable x 3 weeks." The last documented weight on record was on 8/2/21 and the RN assessment did not indicate a current weight for the resident. Resident 7's weight on 8/13/21, two days after the RN assessment, was 136.2 pounds, which constituted an 11.8 pound or 7.97 % weight loss since 8/2/21, which is considered severe, and an 18.8 pound or 12.13% weight loss since 6/18/21. There was no documented evidence the facility evaluated the resident, determined what actions and interventions were needed for the resident, updated the service plan and referred the resident to the facility RN when the resident experienced continued weight loss. Resident 7's documented weights subsequent to 8/13/21 were as follows: *8/20/21 138.4, + 2.2 pounds;*8/25/21 142.8, + 4.4 pounds;*8/27/21 146.8, + 4 pounds; and*9/3/21 146.8. The above weight gain constituted a total 10.6 pounds or 7.8% of his/her body weight between 8/13/21 and 8/27/21. There was no documented evidence the facility evaluated the resident, determined what actions and interventions were needed for the resident, updated the service plan and referred the resident to the facility RN when the resident experienced the weight gain. Staff 19 (CG), reported during an interview on 9/8/21 that Resident 7 was in a lot of pain and "did not eat much" after his/her return from the hospital for hip replacement surgery on 8/1/21. Staff 19 reported the resident's appetite improved when her pain diminished and is eating well.b. Resident 7 experienced multiple short-term changes of condition related to skin and edema which were not monitored through resolution. The failure of the facility to evaluate the resident when s/he experienced significant changes of condition related to weight, to determine what actions and interventions were needed, refer the resident to the facility RN, update the service plan and monitor changes of condition through resolution was discussed with Staff 1 (ED) and Staff 2 (RN) on 9/8/21. They acknowledged the findings. 2. Resident 6 was admitted to the facility in April 2021 with diagnoses including Alzheimer's Disease. Review of the resident's 6/13/21 through 9/7/21 progress note, service plans, temporary service plans and physician communications revealed the resident experienced multiple short-term changes of condition without documented monitoring until resolution and/or resident specific directions to staff in the following areas:* Medication changes;* Urinary urgency;* 7/24/21 fall;* Increase in episodes of crying; and* Decreased food intake. The need to provide clear instruction to staff on all shifts when residents experience short-term changes of condition and monitor the changes through resolution was discussed with Staff 1 (ED), Staff 2 (RN) on 9/8/21. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0040(1-2) Change of Condition and Monitoring.1. Resident #3 - HWD assessed for yeast infection and put skin integrity note in place. At time yeast infection is resolved. 4/14/212. Staff will document skin condition with Skin Report Cards and Shower Schedule per policy. HWD will provide a weekly skin assessment for all residents added to skin Management System until resolved.3. Skin report Cards and Open Area Flow Sheets - Skin management Reports will be reviewed by HWD and ED at Daily Clinical Meeting.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by 5/15/21OAR 411-054-0040(1-2) Change of Condition and Monitoring.1. Resident #7 - HWD assessed for weight loss and completed sig change of condition and update plan for monitoring and TSP in place for meal monitoring. Placed on nutrition at risk and weekly weights. Resident #6 - ED completed a COC service plan with clear instructions for staff regarding medication changes, crying and urinary frequency, food intake, redirections.2. Weekly weights will be reviewed weekly by ED for changes and HWD will complete and significant changes assessment.3. Weekly weights and alert charting will be reviewed by HWD and ED at Daily Clinical Meeting.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by10/1/21

Citation #3: C0280 - Resident Health Services

Visit History:
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Corrected: 11/17/2021
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure the RN performed an assessment, developed interventions based on the condition of the resident, and updated the service plan for 1 of 1 sampled resident (# 7) who experienced severe weight changes. Resident 7 experienced severe weight loss and weight gain. Findings include, but are not limited to:1. Resident 7 was admitted to the facility in February 2020 with diagnoses including Alzheimer's Disease. Review of Resident 7's clinical record revealed the resident experienced a significant weight loss on 7/21/21. The facility failed to ensure the RN completed a timely, thorough assessment, with interventions based on findings added to the service plan. The resident continued to experience severe weight loss followed by severe weight gain without documented evidence of an RN assessment. Refer to C 270.The failure of the facility to ensure a thorough RN assessment was completed timely when residents' experienced significant changes of condition and included interventions based on findings added to the service plan was discussed with Staff 1 (ED) on 9/10/21. She acknowledged the findings.
Plan of Correction:
OAR 411-054-0045 (1)(a-f)(A)(C_F) Resident Health Services1.Resident 7 weight reveiwed and significant change of condition note made by HWD on 9/8/21. Added to nutrition at risk, TSP in place to assist with meals if not eating. 2. RCC gave ED list of daily and weekly weights and ED will review and ED will follow up with HWD of any weight changes, loss or gain. 3. Will be reviewed daily at Clinical Meeting, with HWD and ED. 4.Responsible parties: ED, HWD, or designess Community will be in compliance by 10/1/21

Citation #4: C0290 - Res Hlth Srvc: On- and Off-Site Health Srvc

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Corrected: 6/13/2021
Inspection Findings:
2. Resident 5 was admitted to hospice services on 4/1/21. Outside service notes, temporary service plans, current service plan and progress notes were reviewed. On 4/6/21, hospice recommended the facility obtain weekly weights for the resident and elevate his/her legs due to bilateral lower extremity edema. On 4/12/21 at 3:33 pm, Resident 5 was observed in a recliner chair without his/her legs elevated. Observations of the resident on 4/13/21 from 8:40 am through 10:53 am also revealed Resident 5 in the recliner resting without legs elevated. During an interview with Staff 5 and Staff 8 (Resident Assistants) on 4/13/21 at 9:47 am, staff verified the resident's legs were not being elevated and they were unaware of the need to weigh the resident weekly. There was no documented evidence the hospice recommendations had been communicated to staff. In an interview on 4/13/21 at 10:35 am with Staff 1 (ED) and Staff (2), they verified the lack of communication. The need to ensure coordination of care was provided by communicating outside provider recommendations to staff was discussed with Staff 1 and Staff 2. They acknowledged the findings.
Based on observation, interview and record review, it was determined the facility failed to ensure written recommendations made by outside service providers were incorporated in resident's service plan as applicable, and the instructions were made available to staff for provision of supplemental care for 2 of 4 sampled residents (#s 1 and 5) who received outside services. Findings include, but are not limited to:Review of Resident 1's clinical record noted s/he had been receiving Home Health Physical Therapy and Occupational Therapy. Home Health visit notes provided by the facility indicated the outside provider had left the following recommendations for care:* 3/11/21: "Continue to encourage sitting therapy exercises" (handout sheets left in the resident's room); and* 3/15/21: "Continue to encourage range of motion of left upper extremity and proper sitting position."There was no documented evidence the facility had communicated the recommendations to staff.On 4/14/21 the need to ensure recommendations from outside service providers were reviewed and interventions added to the service plan and communicated to staff as appropriate for provision of care was discussed with Staff 1 (ED) and Staff 2 (RN). They acknowledged the findings.
Plan of Correction:
OAR 411-054-0045(2) Res Hlth Srvc: On-and off-site Srvc.1. Resident 1: Temporary Service Plan put in place for staff to follow PT exercise recommendations and Exercises posted in resident apt for staff to follow 4/14/21.Resident 5: Temporary Service Plan with hospice recommendations for leg elevation put in place and weekly weights added to MAR to complete, 4/13/21.2. HWD will review Third Party Notes and add recommendations as appropriate, per policy. 3. HWD and ED will review Third Pary Notes each week at clinical meeting.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by 5/15/21

Citation #5: C0303 - Systems: Treatment Orders

Visit History:
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Corrected: 11/17/2021
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure written, signed physician orders were documented in the resident's facility record for all medications the facility was responsible to administer for 1 of 2 sampled residents (#7) whose facility records were reviewed. Findings include, but are not limited to: Resident 7 was admitted to the facility in February 2020 with diagnoses including Stage II chronic kidney disease. Resident 7's 8/5/21 signed physician orders and 8/5/21 through 9/7/21 MAR were reviewed. Resident 7 was administered Metolazone (diuretic) every other day between 8/5/21 and 9/7/21. There was no documented evidence of a signed physician order for the medication located in the resident's facility record. The need to ensure signed physician or other legally recognized practitioner orders were documented in the resident's record for all medications the facility was responsible to administer was discussed with Staff 1 (ED) and Staff 2 (RN) on 9/8/21. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0055 (1)(f-h)Systems: Treatment Orders1. MD responded with clarification of medication and PCC MAR was updated. 2. Pending clarifications will be resent daily until response provided and PCP office will be called with follow up after 2 days of no response. 3. Daily, by RCC, HWD, or ED at clinicial meeting4. Responsible Parties: ED, HWD, or designee. Community will be in compliance by 10/1/21

Citation #6: C0310 - Systems: Medication Administration

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Corrected: 6/13/2021
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure MARs were accurate, included clear parameters, and had medication specific instruction to direct non-licensed staff for 1 of 5 sampled resident (#4) whose medications were reviewed. Findings include, but are not limited to: Resident 4 was admitted to the facility in March 2017 with diagnoses including Chronic Obstructive Pulmonary Disorder (COPD) and Type 2 Diabetes.Resident 4's 4/1/21 through 4/12/21 MAR and progress notes were reviewed and noted the following:* Resident 4 had orders for a Dulera inhaler to be administered twice a day for COPD. Staff documented on the MAR the inhaler was administered on 4/2/21 and 4/9/21 and the resident refused on 4/1/21, 4/3/21, 4/5/21, 4/6/21, 4/9/21, and 4/11/21; however, progress notes 4/1/21 through 4/12/21 revealed the Dulera inhaler was not available at the facility. During an interview on 4/14/21 with Staff 1 (ED), she confirmed the Dulera inhaler was unavailable and not at the facility.* Resident 4 had orders for the facility to obtain a daily fasting blood sugar reading at 6:00 am. The MAR failed to include clear written parameters for responding to low or high blood sugars and when to notify the RN or physician.The need to ensure MARs were accurate, included clear parameters and provided medication specific instruction to direct non-licensed staff was discussed with Staff 1 (ED) and Staff 2 (RN) on 4/14/21. They acknowledged the findings.
Plan of Correction:
OAR 411-054-0055(2) Systems: Medication Administration.1. Resident 4: Parameters - HWD put parameters in place for fasting CBG 4/14/21. Resident 4: MD d/c'd Dulera 4/15/212. HWD reviewed all diabetic resident MARS and ensured parameters were in place for all CBG checks. 4/15/21. Med Tech training to review proper documenation for refused meds and meds on hold, completed 4/16/21.3. HWD will run refused medication report and medication on hold report and audit to see documentation was done correctly prior to Clinical meeting with ED.4. Responsible Parties: HWD, ED, or designee.This community will be in compliance by 5/15/21

Citation #7: C0455 - Inspections and Investigation: Insp Interval

Visit History:
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Not Corrected
4 Visit: 1/21/2022 | Not Corrected
5 Visit: 8/9/2022 | Corrected: 5/31/2022
Inspection Findings:
Based on interview and record review, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Department. Findings include but are not limited to:Refer to C 270 and C 513.
Based on observation, interview and record review, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Division. This is a repeat citation. Findings include, but are not limited to:Refer to C 513.



Based on interview, it was determined the facility failed to ensure their re-licensure survey plan of correction was implemented and satisfied the Department. This is a repeat citation. Findings include, but are not limited to:Refer to C 513.Refer to C513 POC
Plan of Correction:
OAR 411-054-0105 (2-3) Inspections and Investigaion: Insp IntervalRefer to C270 and C513Refer to C513 POC

Citation #8: C0513 - Doors, Walls, Elevators, Odors

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Not Corrected
4 Visit: 1/21/2022 | Not Corrected
5 Visit: 8/9/2022 | Corrected: 5/31/2022
Inspection Findings:
Based on observation and interview, it was determined the facility failed to ensure the environment was clean and maintained in good repair. Findings include, but are not limited to:Observations of the facility on 4/12/21 through 4/13/21 showed the following areas were in need of cleaning and/or repair:* Chairs and table legs throughout the facility were gouged, dinged and scratched;* Multiple high back, fabric chairs were frayed and had stains; * An area of the carpet in the Topaz unit near the laundry room had damage, exposing the fibers, and stains; and* Multiple baseboards throughout the facility had scratches, gouges and areas of exposed wood.The environment was toured and the need to maintain interior and exterior surfaces in clean and good repair was discussed with Staff 1 (Executive Director) on 4/13/21. She acknowledged the findings.
Based on observation and interview, it was determined the facility failed to ensure the environment was clean and maintained in good repair. This is a repeat citation. Findings include, but are not limited to:Observations of the facility on 9/7/21 revealed the following areas were in need of cleaning and/or repair:* Chairs and table legs throughout the facility were gouged, dinged and scratched; and* Multiple high back, fabric chairs were frayed and had stains. The environment was toured and the need to maintain interior surfaces clean and in good repair was discussed with Staff 1 (ED) on 9/7/21. She acknowledged the findings.

Due to the facility requesting an extension, the plan of correction date was extended to 12/1/21 for facility environmental areas. The facility remains out of compliance.





Based on interview, it was determined the facility failed to ensure the environment was clean and maintained in good repair. This is a repeat citation. Findings include, but are not limited to:The facility requested an extension to correct the environmental areas previously cited, but was not in compliance on 01/21/22. Staff 1 (ED) acknowledged the findings on 01/21/22.1. Today, based on our knowledge, the remodel for BKD Roseburg that includes replacement of all common area and dining furniture, all common area carpet replacement, baseboard replacement, is to begin in Q1 of 2021, and forecasted completion in 6 months 2. All new furniture has been ordered to replace existing furniture in all dining rooms and common areas. 3. All furniture cleaning will be maintained per monthly schedule in TELS programing. 4. ED, Maint Tech, or designee.
Plan of Correction:
OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors. 1. Damaged Carpet area in Topaz hall will be repaired by Sherwin WIlliamsBaseboard gouges will be filled, baseboards painted, and damaged areas of baseboard will be replaced. Furniture to be replaced in 1st quarter of 2022 - extension requested. 2. Maint Tech will touch up baseboards as needed each month. Chairs will be cleaned as able per wkly schedule. 3. monthly per TELS system.4. Responsible Parties: ED or designee.OAR 411-054-0200 (4)(d-i) Doors, Walls, Elevators, Odors. 1. Furniture to be replaced in 1st quarter of 2022 -Budget is $950,000. extension requested. 2. Design team will walk through on Oct 5th, to firm furniture order. Furniture will be ordered in 4th quarter of 2021 and replaced in 1st quarter 2022 Chairs will be cleaned as able per wkly schedule. 3. monthly per TELS system.4. Responsible Parties: ED or designee.1. Today, based on our knowledge, the remodel for BKD Roseburg that includes replacement of all common area and dining furniture, all common area carpet replacement, baseboard replacement, is to begin in Q1 of 2021, and forecasted completion in 6 months 2. All new furniture has been ordered to replace existing furniture in all dining rooms and common areas. 3. All furniture cleaning will be maintained per monthly schedule in TELS programing. 4. ED, Maint Tech, or designee.

Citation #9: Z0142 - Administration Compliance

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Not Corrected
4 Visit: 1/21/2022 | Not Corrected
5 Visit: 8/9/2022 | Corrected: 5/31/2022
Inspection Findings:
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 C513.
Based on observation and interview, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. This is a repeat citation. Findings include, but are not limited to:Refer to C 513.

Based on interview and record review, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. This is a repeat citation. Findings include, but are not limited to:Refer to C 513.





Based on interview, it was determined the facility failed to follow licensing rules for Residential Care and Assisted Living Facilities. This is a repeat citation. Findings include, but are not limited to:Refer to C 513.refer to C513 POC
Plan of Correction:
Refer to deficiencies C513 and POCRefer to deficiencies C513 and POCrefer to C513 POC

Citation #10: Z0162 - Compliance With Rules Health Care

Visit History:
1 Visit: 4/14/2021 | Not Corrected
2 Visit: 9/8/2021 | Not Corrected
3 Visit: 11/17/2021 | Corrected: 11/17/2021
Inspection 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 C270, C290 and C310.
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. This is a repeat citation. Findings include, but are not limited to:Refer to C 270, C 280 and C 303.
Plan of Correction:
Refer to deficiencies C270, C290, C310 and POCRefer to deficiencies C270, C280, C303 and POC