Country Meadows Village

Based on observation and interview, it was determined the facility failed to ensure the kitchen was maintained in accordance with Oregon Food Sanitation Rules. Findings include, but are not limited to:

Observations of the kitchen were made at 10:55 am on 08/26/25. The following was identified:

a. A build-up of dust, grease, and/or food splashes/debris was observed on the following:

* The knife rack and wall behind the pastry prep area;
* The plate holder, shelves, and walls around the hot food pass;
* The sides, front, and knobs of the grill and fryer;
* On the counter under the soda machine; and
* In the cupboard and drain under the soda machine.

b. The following was in need of repair/replacement:

* The temperature gauge and the small thermometer in the walk-in refrigerator; and
* Several rubber spatulas were worn with pieces of rubber broken off.

c. Staff 4 (Cook) did not know where the test strips for the sanitizer solution were located. The strips were located by Staff 3 (Independent Living Kitchen Manager); however, they had expired in 2022.

d. There were no alcohol wipes available for staff to sanitizer small diameter thermometers used for temping food.

The kitchen was toured and the above areas were discussed with Staff 1 (ED) and Staff 2 (RN) at 12:08 pm on 08/26/25. They acknowledged the findings.

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:

The findings of the kitchen inspection, conducted 08/31/23, 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 re-visit to the kitchen inspection of 08/31/23, conducted on 10/19/23, are documented in this report. The facility was found to be 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 in accordance with the Food Sanitation Rules OARs 333-150-0000. Findings include, but are not limited to:On 08/31/23, between 10:45 am and 12:45 pm, the kitchen was observed to need cleaning in the following areas: * Black matter on perimeter of floor and around appliance feet throughout kitchen;* Food debris on floor behind prep table; * Brown matter buildup and debris on handle base of convection oven;* Orange debris on metal housing and knife of commercial can opener;* Black debris on fan cage mounted to wall in walk-in refrigerator; and * Peeling coating and rust on grate of beverage machine, creating an uncleanable surface. The above areas were shown to Staff 1 (Executive Chef) and Staff 2 (Regional Culinary Director) on 08/31/23. The findings were acknowledged.

Assisted Living and Residential Care Facilities must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the complaint investigation conducted 02/15/2023. The facility was evaluated for compliance with Oregon Administrative Rule 411, Division 54 and if applicable, Oregon Administrative Rule 411, Division 57. The following deficiencies were identified:Abbreviations possibly used in this document:ADL: activities of daily livingbid: twice a dayCBG: capillary blood glucose or blood sugar cc: cubic centimeterCG: caregivercm: centimeterF: FahrenheitHH: Home HealthHS or hs: hour of sleepLPN: Licensed Practical NurseMA: Medication AideMAR: Medication Administration RecordMCC Memory Care Communitymg: milligramml: milliliterO2 sats: oxygen saturation in the bloodOT: Occupational TherapistPT: Physical TherapistPRN: as neededqd: every day or dailyqid: four times a dayRN: Registered NurseSP: service planTAR: Treatment Administration Recordtid: three times a day

Based on interview, observation, and record review it was confirmed the facility failed to fully implement and update an Acuity Based Staffing Tool (ABST). Findings include:During an onsite interview on 02/15/2023, Staff #1 (S1) stated the following, " There are residents who no longer live there who need to be archived and residents who have moved in and have not yet been added to the tool. " Resident #4-5 (R4 and R5) moved into the facility a week or two ago. " For swing shift the ABST, posted staffing plan, and schedule states there are 2 Caregivers (CG) and 1 Med Tech (MT) working. " R4 moved in on 2/3/2023 and R5 moved in on 2/9/2023.During an unannounced site visit on 02/15/2023, The Compliance Specialist (CS) observed 2CG and 1 MT on duty. A record review of the Posted Staffing Plan, Staff Schedule for February 2023, Resident #3 (R3) Service Plan, Progress Notes, the breakdown of their care on the facility's ABST, and the States internal ABST website. The States internal website shows resident #4-5 were not currently entered into the tool. On 02/15/2023, these findings were reviewed and acknowledged by S1.

The findings of the re-licensure survey, conducted 01/17/23 through 01/19/23, 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 Home and Community Based Services Regulations OARs 411 Division 004.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 re-visit to the re-licensure survey of 01/19/23, conducted 04/07/23, 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 and OARs 411 Division 004 for Home and Community Based Services Regulations.

Based on observation and interview, it was determined the facility failed to ensure all interior materials and surfaces were kept clean and in good repair. Findings include, but are not limited to:The interior of the facility was toured on 01/17/23 at 11:05 am. a. The following areas needed repair:* The linoleum floor behind the washer and dryer equipment in Laundry Room A and Laundry Room B was torn making it an uncleanable surface; and* The wall under the wastewater outlets of both washing machines in Laundry Room A had flaking and peeling paint caused by water damage. b. The following areas needed cleaning: * The ceiling vent in the dining area directly above the window for passing food trays from the kitchen was covered with layers of dust; and * Kitchen cabinet surfaces in the Activity Room had dried debris and were sticky.The building was toured and areas needing cleaning or repair were discussed with Staff 1 (Executive Director) and Staff 3 (Maintenance Director) at 09:40 am on 01/18/23. They acknowledged the areas needing cleaning and repair.

Based on observation and interview, it was determined the facility failed to provide exit door alarms or other acceptable systems for security purposes and to alert staff when residents exit the ALF. Findings include, but are not limited to:The interior of the facility was toured on 01/17/23 at 11:05 am. * The doors leading to the central courtyard lacked a system that alerted staff when a resident exited the building.The building was toured and areas needing alarms were discussed with Staff 1 (Executive Director) and Staff 3 (Maintenance Director) at 09:40 am on 01/18/23. They acknowledged the need to install exit door alarms.