Timberhill Place

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 facility kitchen areas were reviewed on 01/30/25 from 10:15 am through 1:15 pm and found the following: a. An accumulation of food spills, splatters, loose food and trash debris, dirt, dust, and/or black matter was visible on or underneath the following: * Kitchen drains; * Walk in freezer floor; * Toaster; * Interior of convection and conventional ovens; * Stove top and; * Floors under and in between equipment/corners and edges. b. The following areas were in need of repair: * Section of the base cove pealing away from wall; * Areas in dish washing section with missing caulking; * Area in flooring by doors with gap and build up of dirt/debris; * Holes/gaps in ceiling where pipes entering/exiting kitchen. c. Multiple potentially hazardous food items stored in walk-in cooler that were not dated when opened/prepared. Items observed in the walk-in cooler that were past the allowable seven days after preparation/opening. Multiple items in walk-in cooler, walk in freezer and dry storage that were not covered/protected from potential contamination. d. Disposable/single use utensils were stored uncovered and exposed to potential contamination. e. Staff were observed storing dishwashing racks and used large pans on the floor in front of the dishwasher prior to washing. No food or equipment should be placed or stored on the floor. f. Multiple sanitation rags were observed stored on counter tops out of the sanitation bucket/fluid. During tray line service, staff was observed to wipe their gloves with the sanitation rag potentially contaminating the gloves and continued to use the gloves in attempt to clean or sanitize them. Gloves can not be sanitized and must be removed and discarded. g. Cook was observed to handle and wash dirty dishes, using sprayer. No protective covering was worn to protect his outer layer of clothing from contamination from dirty dishes. Cook was then observed to prepare and serve food with potentially contaminated out clothing. h. Multiple cutting boards were noted to have deep scored and/or staining and in need of repair or replacement. Large non-stick sauté pan was observed to have multiple worn areas/scratches and was in need of replacement. Multiple hot pads were found with holes/worn areas and in need of replacement. At approximately 1:00 pm, surveyor reviewed above areas with staff 1 (Executive Director) who acknowledged the identified areas.

a. Immediate re-education of food Sanitation and kitchen cleanliness will be completed with all kitchen employees. The kitchen cleaning chart will be updated to include routine cleaning of kitchen drains, Walk-in freezer floor, toaster, interior of convection and conventional ovens, stove tops and floors under equipment. The Food Service Director will be responsible for a weekly audit of these areas to ensure the kitchen remains in compliance. b. Immediate repairs will be made to all walls, missing caulking, flooring and holes, gapes in ceiling.The Food Director will be responsible for a weekly audit of these areas to ensure the kitchen remains in good repair. c. Immediate re-education of proper food storage and proper dating of food and removal of food will be completed with all kitchen staff. The Food Service Director will be responsible for a weekly audit of all food storage to ensure the kitchen remains in compliance. d. All disposable utensils will be stored in a covered a covered container. All kitchen staff will be re-educated on this and the Food Service Director will be responsible to ensure that all disposable untensils are stored correctly. e. Immediate re-education of proper placement of dishwashing racks and pans prior to washing them. A cart will be used to place these items on prior to washing them. The Food Service Director will be responsible to ensure the proper storage of pans and racks will be followed by all kitchen staff. f. Immediate re-education of proper storage of santiation rags with all kitchen staff. The Food Service Director will be resonsible to audit this on a continues based to ensure that the kitchen remains in compliance. Tongs and other serving equipment will be used when serving food. g. Rubber aprons will be purchased and a protocal will be put in place for all kitchen staff to wear while washing dishes. The apron will be removed between serving food and dish washing to prevent contaminated clothing. The food service director will be responsible for ensuring that the apron is used properly. h. All damaged or stained cutting boards and pans and damaged hot pads will be replace immediately. All kitchen staff will be re-educated on reporting damaged items to the Food Service Director who will be held accountable to replace and damaged items immediately.

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 interview and record review, it was determined the facility failed to have a system in place for accurately tracking controlled substances administered by the facility for 1 of 2 sampled residents (#2) whose MARs and Controlled Substance Disposition logs were reviewed for accuracy. Findings include, but are not limited to: Resident 2 was admitted to the facility in 07/2023 with diagnoses including chronic pain.   The resident had an 08/10/23 signed physician order for oxycodone 2.5 mg every 30 minutes as needed for pain and for respirations over 25. Staff were instructed to call the hospice provider if the resident needed three doses in 90 minutes or five doses in one day. Resident 2's Controlled Substance Disposition logs and MARS, reviewed from 8/10/23 through 09/06/23 showed the following: * On 08/12/23 one dose of PRN oxycodone was signed as administered on the MAR but five doses were signed as given on the disposition log; * On 08/13/23 there was no indication PRN oxycodone was administered on the MAR but four doses were signed as given on the disposition log; * On 08/14/23, there was no indication PRN oxycodone was administered on the MAR but two doses were signed as given on the disposition log; * On 08/15/23 one dose of PRN oxycodone was signed as administered on the MAR but three doses were signed as given on the disposition log: and * On 08/26/23 one dose of PRN oxycodone was signed as administered on the MAR but two doses were signed as given on the disposition log. b. Documentation on the disposition log showed multiple doses of PRN oxycodone were administered at the same time on 08/12/23, 08/13/23, 08/14/23, 08/15/23 and 08/26/23 not according the order which instructed staff to administer one dose every 30 minutes. The need to ensure narcotic disposition logs and MARs were accurate and medications were recorded appropriately was discussed with Staff 1 (Administrator) and Staff 2 (RN Consultant) on 09/07/23. They acknowledged the findings.

1. Immediate re-education done with medication managers re: a) Verification of eMAR against card(s) of medication(s), as well as recorded orders in Narcotic Control Book, before administration of medication. b) Documentation of administered meds in eMAR and Narcotic Control Book. 2. Narcotic Control Book procedures reviewed and updated. a) Any time Narcotics are dispensed as other than a full tablet (e.g. each bubble's unit dose is only a half-tablet or is one-and-one-half tablets) these will now be counted in as such, and count in book decremented by actual tablet amounts, not just "1" for a bubble being popped. b) Specific instructions to consult the RN if a new narcotic order is received but is not yet on hand, and a supply of the same medication for the same resident is on hand. 3. Varies. a) At each shift change. b) Weekly (review of Narcotic Control Book and verification against eMAR and written orders.) c) Monthly (audit) 4. Facility Nurse will be responsible to see that: a) On-coming and off-going Medication Manager will verify at each shift change during narcotic count. b) Facility Nurse or Resident Care Manager will perform weekly review as listed above in section 3. c) Facility Nurse or Resident Care Manager will perform monthly audit as listed above in section 3.

The findings of the re-licensure survey conducted 09/05/23 through 09/07/23 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 and OARs 411 Division 004 Home and Community Based Services Regulations. Abbreviations possibly used in this document: ADL: activities of daily living bid: twice a day CBG: capillary blood glucose or blood sugar cc: cubic centimeter CG: caregiver cm: centimeter F: Fahrenheit HH: Home Health HS or hs: hour of sleep LPN: Licensed Practical Nurse MA: Medication Aide MAR: Medication Administration Record MCC: Memory Care Community mg: milligram ml: milliliter O2 sats: oxygen saturation in the blood OT: Occupational Therapist PT: Physical Therapist PRN: as needed qd: every day or daily qid: four times a day RN: Registered Nurse SP: service plan TAR: Treatment Administration Record tid: three times a day

The findings of the first revisit to the re-licensure survey of 09/07/23, conducted on 12/06/23, 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.

Based on observation, interview and record review, it was determined the facility failed to ensure the kitchen was clean and maintained in good repair, kitchen staff did not follow hygienic practices, and proper food handling procedures were not followed in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: On 01/04/23 at 10:30 am, the main kitchen and walk-in refrigerator were observed to need cleaning in the following areas: a. Kitchen area; * Walls throughout the kitchen had multiple spills, smears, splatters or black streaks; * Pipes behind multiple appliances had grease, dirt and debris on them; * Vulcan cook top knobs and handles had sticky matter and dried food debris on them;   * Interior walls of ice-maker machine had unidentified black residue; * Floors throughout the kitchen including the broom closet had black matter build-up, food debris and grease in corners, under equipment and around perimeter edges; * Brooms stored on the floor; * Cooling racks and kitchen utensils had rust and grease on them; * Storage containers and racks for clean dishes were dirty; * Oven interior, knobs, doors and handles; * Convection oven interior, racks and doors; * Microwave interior, doors and handles; * Toaster; * Industrial mixer, base of blender and scale; * Ceiling fire sprinklers; * Ceiling vents; * Smoke detectors; * Air-intake inlet on air-conditioning unit was covered with dirt and dust;   * Rolling carts; * Open shelving throughout the kitchen; and * Electrical outlets. b. Walk-in refrigerator: * Refrigerator cooling unit fans had a layer of dust and dirt. Ceiling of walk in refrigerator with dust build up from fans. Ready to serve items stored under the unit uncovered and open to direct dust and debris contamination from blowing fans. c. Dining room beverage area; * Juice and hot coco machines observed with splatters and fluid build up. * Dining room was preset with cups and silverware prior to lunch service. Staff 2 (Food Service Director) verified that after each meal service tables were cleared, cleaned and then the next meal service was set. Staff 2 verified that breakfast meal service items were set after dinner and left in dining room over night. Dining room was not closed off to residents or staff during the night leaving the preset service items vulnerable to potential contamination. On 01/04/23 at 10:30 am, the main kitchen was observed to need the following repairs: * Blade on can opener observed with protective coating removed from ware and rust developing; and * Bottom shelf on stainless steel table for storing cleaning products next to employee hand-washing sink noted with buildup of chemicals and stored on cardboard that was damaged/wet and needed to be disposed. * Flooring around leg of clean area of dish machine was damaged. * Kitchen thermostat box surrounded by foam padding for staff protection was dirty and a heavy layer of dust observed in and around the unit. On 01/04/23 at 10:30 am, kitchen staff was observed not following proper hygienic practices: * Two kitchen staff were observed not using effective hair restraints. On 01/04/23 at 10:30 am, the following improper food handling practices were observed: * Staff 2 (Food Service Director) was observed using single-use gloves for multiple tasks, including food handling, cooking and operating appliances; kitchen staff observed using sanitation rags to wipe gloved hands during meal service; * Raw eggs were observed stored in the walk-in refrigerator already cracked and/or pooled and without any date or time notation.  Staff 2 verified eggs were pre cracked for use for breakfast service the next day; * Individual portions of food were plated on trays in the walk-in refrigerator and left uncovered; and * Multiple food items in the walk-in refrigerator were found removed from its original packaging, not dated and only partially wrapped. Bulk food items (milk/liquid eggs/half and half, etc) were found not dated when opened. *Multiple cutting boards were found heavily scored and/or stained and in need of replacement. *Multiple green/grey beverage cups/mugs found heavily stained with protective glaze worn off. *Industrial mixer was not covered when not in use as required. Additionally, multiple dishwasher racks were stored on the floor. Kitchen staff observed placing/storing used pans on the floor prior to placing in dishwasher. Multiple clean pots/pans and dishes were stored on the bottom shelf directly next to a garbage disposal unit putting the clean dishes at risk of potential contamination for the disposal unit. The findings were discussed with Staff 2 (Food Service Director) on 01/05/23 at 12:55 pm and Staff 1 (Executive Director) on 01/05/23 at 1:50 pm. Both staff acknowledged the findings.

All surfaces of the kitchen will be deep cleaned by a Janatorial company including floors, ceiling, vents, kitchen equipments, walls, racks and air conditioner. The fire sprinkler will be replace by Western States Fire and will be inspected by them yearly. A Kitchen cleaner will be hired to mainatian the cleanliness of the kitchen as scheduled several times weekly.The Ice maker will be cleaned and scheduled for a cleaning monthly. New cooling racks have been ordered to replace the rusted ones. All racks have been added to the weekly cleaning schedule The broom closet will be deep cleaned and added to the weekly cleaning schedule. A sign will be posted to remind staff to always hang up the brooms. The walk-in refigerator will be deep cleaned including ceiling, fans and racks. Food under the fans will be kept covered. The dining room will be closed  when the kitchen crew leaves for the day. The doors will be closed and a sign near the dining room will state it is closed until morning. A flooring company will be repairing or replacing the damaged floor under the dishwasher leg. The kitchen staff are now wearing proper hair restraints and the cook on shift will responsible to ensure staff are wearing their hair restraints each shift. Education on proper food handling and storage of food, wearing and changing of gloves will be monitored each shift with the ensuring the proper proceedures are followed. Replacement of cutting boards have been ordered. Replacement plastic cups have been ordered. Cover for mixer has been ordered. A cart has been order to store dish washer racks on insteated of the floor. a divider has been place between the disposal unit to prevent chemical exposure to clean pots and pans.The Executive Director and the Food Service Director will be responsible for the completion and monitoring of these corections by March 6, 2023

The findings of the kitchen inspection, conducted 1/5/23, 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 01/04/23, conducted 03/29/23, 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.