Avamere at Hermiston

Based on observation, interview, and record review, it was determined the facility failed to maintain the kitchen in a sanitary manner and ensure food was prepared and served in accordance with OAR 333-150-0000 (Food Sanitation Rules). Findings include, but are not limited to:

On 07/30/25, interviews with staff and observations of the facility kitchen, food storage areas, food preparation, and food service were conducted. The following was identified:

a. An accumulation of food spills, splatters, loose food, dirt, dust, black matter, and grease was visible on or underneath the following:

* Flooring throughout;
* Walls around large equipment, food preparation areas, and in the dry storage room;
* Food traps and/or floor drains located under the ice machine, under the ware wash machine, under the hot line, and under the back food preparation area;
* Open shelving in cabinets throughout the kitchen;
* Open wire rack shelving located throughout the kitchen and dry storage;
* The caulking throughout the ware wash area;
* Industrial can opener casing;
* Vents located on the ceiling and ice machine; and
* The ceiling around the fire sprinkler in the dry storage room.

b. The following areas were noted in need of repair:

* Cabinets to the right of the ice machine were missing baseboard material approximately five feet in length;
* Doors to the janitorial closet, dry storage, and to a facility corridor had multiple chips exposing material; and
* There were broken baseboard tiles on the ends of both walls leading to the ware washing area.

c. The facility lacked the required testing strips to ensure proper sanitizing was completed throughout the kitchen, including food contact and non-food contact surfaces.

d. Two garbage cans were observed uncovered throughout meal preparation and meal service.

On 07/30/25 at 2:01 pm, Staff 1 (Executive Director), Staff 2 (Dietary Services Manager), and Staff 3 (Cook), toured the facility kitchen and food storage areas with this surveyor and acknowledged areas identified above.

The need to ensure the kitchen was maintained in a sanitary manner and food was prepared and served in accordance with Food Sanitation Rules was discussed with Staff 1 and Staff 2 on 07/30/25 at 2:18 pm. 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 re-licensure survey, conducted 07/22/24 through 07/24/24, 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 and OARs 411 Division 004 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 first re-visit to the re-licensure survey of 07/24/24, conducted 10/14/24 through 10/15/24, 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 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 second revisit, to the relicensure survey of 07/24/24, conducted 11/20/24, are documented in this report. It was determined the facility was in compliance with OARs 411 Division 54 for Residential Care and Assisted Living Facilities and Home and Community Based Services Regulations OARs 411 Division 004.

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 2 of 4 sampled residents (#s 2 and 4) whose MARs and Controlled Substance Drug Disposition logs were reviewed for accuracy. Findings include, but are not limited to:1. Resident 2 was admitted to the facility in 06/2024 with diagnoses which included pain.Resident 2 had an order for oxycodone (narcotic analgesic) 10 mg every six hours as needed for pain.Resident 2's Controlled Substance Disposition Logs and MARs, reviewed from 07/01/24 through 07/22/24, revealed six occasions when staff signed on the drug disposition log that the oxycodone was given. However, the MAR lacked documentation that the resident received the medication. Inconsistencies between the MARs and Controlled Substance Disposition Logs were reviewed with Staff 1 (Executive Director) on 07/23/24 at 3:15 pm. She reviewed the documentation and acknowledged the discrepancies. 2. Resident 4 was admitted to the facility in 01/2024 and had diagnoses which included pain.Resident 4 had an order for hydrocodone-acetaminophen (narcotic analgesic) 5-325 mg, one tablet every eight hours as needed for pain.Resident 4's Controlled Substance Disposition Logs and MARs, reviewed from 07/01/24 through 07/22/24, revealed staff signed on the drug disposition log that the hydrocodone was given on 07/18/24. However, the MAR lacked documentation that the resident received the medication. Inconsistencies between the MAR and Controlled Substance Disposition Log were reviewed with Staff 1 (Executive Director) on 07/24/24 at 9:30 am. She reviewed the documentation and acknowledged the discrepancy.

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 2 of 2 sampled residents (#s 5 and 7) whose MARs and Controlled Substance Drug Disposition logs were reviewed for accuracy. This is a repeat citation. Findings include, but are not limited to:1. Resident 5 was admitted to the facility in 08/2024 with diagnoses which included pain.The resident had an order for hydrocodone-acetaminophen (narcotic analgesic) 5-325 mgs every four hours as needed for pain.Resident 5's Controlled Substance Disposition Logs and MARs, dated 09/22/24 through 10/14/24, were reviewed and revealed two occasions when staff signed on the drug disposition log that the hydrocodone-acetaminophen was administered, but the MAR lacked documentation that the resident received the medication. Inconsistencies between the MARs and Controlled Substance Disposition Logs were reviewed with Staff 1 (ED), Staff 2 (Region Nurse Consultant), Staff 3 (Director of Health Services), and Staff 17 (RCC) on 10/15/24 at 1:45 pm. They acknowledged the findings. 2. Resident 7 was admitted to the facility in 02/2023 and had diagnoses which included pain.The resident had an order for Oxycodone (narcotic analgesic) 10 mgs every six hours as needed for pain.Resident 7's Controlled Substance Disposition Logs and MARs, dated 09/22/24 through 10/14/24, were reviewed and revealed three occasions when staff signed on the drug disposition log that the Oxycodone was administered, but the MAR lacked documentation that the resident received the medication. Inconsistencies between the MARs and Controlled Substance Disposition Logs were reviewed with Staff 1 (ED), Staff 2 (Region Nurse Consultant), Staff 3 (Director of Health Services), and Staff 17 (RCC) on 10/15/24 at 1:45 pm. They acknowledged the findings.

2. Resident 2 was admitted in 06/2024 with diagnoses which included kidney failure, edema, and hypertension.Resident 2's progress notes, PCP orders, and MARs were reviewed from 07/01/24 through 07/22/24, and the following was revealed:- On 07/11/24, Resident 2's PCP ordered Torsemide (diuretic) 5 mg daily.- According to the MAR, reviewed from 07/01/24 - 07/22/24, s/he did not receive the medication until 07/20/24 (nine days after it was ordered).- A progress note dated 07/18/24, indicated staff contacted the pharmacy to inquire about the medication. The pharmacy reported they never received an order for the medication. - A progress note dated 07/18/24 indicated staff found the order in the "to be filed," and it had not been faxed to the pharmacy to be filled.In an interview with Staff 1 (Executive Director) and Staff 2 (Regional RN) on 07/23/24 at 4:10 pm, Staff 2 verified the medication had not been given as ordered. She stated a med error report would be generated and the PCP would be notified.
Based on interview and record review, it was determined the facility failed to ensure physician orders were carried out as prescribed for 2 of 4 sampled residents (#s 1 and 2) whose orders were reviewed. Findings include, but are not limited to:1. Resident 1 was admitted to the facility in 11/2023 with diagnoses including high blood pressure.Resident 1's MAR for 07/2024 and physician's orders were reviewed.Resident 1 had physician's orders for Metoprolol Tartrate 25 mg once daily, to be held for systolic blood pressure less than 100.There was no documented evidence Resident 1's systolic blood pressure was measured on July 6th and 10th to determine if the medication should have been held. The medication was signed as administered. On July 19th, the residents systolic blood pressure was documented to be 93. The medication was signed as given, not held as directed.The Metoprolol Tartrate was not held as ordered, and the resident's blood pressure was not consistently documented as monitored to determine administration.The need to ensure physician's orders were carried out as prescribed was reviewed with Staff 1 (Executive Director) on 07/24/24. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure MARs were accurate and included resident-specific parameters for PRN medications for 3 of 3 sampled residents (#s 5, 6, and 7) whose medication administrative records were reviewed. Findings include, but are not limited to:1. Resident 5 was admitted to the facility in 08/2024 with diagnoses including hypertension, atrial fibrillation, and osteoarthritis. The resident's 09/01/24 through 10/14/24 MARs and physician's orders were reviewed and the following inaccuracies were identified: * There were two PRN medications for pain without parameters to direct unlicensed staff on which medication to administer first;* There were two conflicting parameters on a PRN hydrocodone-acetaminophen, a pain medication. One directed staff to "give one tablet by mouth every [six] hours as needed". The second directed staff to administer "one to two tablets every [six] hours PRN"; * Resident 5 had an order for amlodipine (for hypertension). There were parameters on the signed order of when staff should hold the medication, but they were not transcribed onto the MAR; and * There was a parameter for staff to hold the resident's metoprolol (for atrial fibrillation) for a heart rate less than five beats per minute. There was no documented evidence staff had clarified the parameter with Resident 5's physician. The need for resident-specific parameters and clear instruction for unlicensed staff was discussed with Staff 1 (ED), Staff 2 (Region Nurse Consultant), Staff 3 (Director of Health Services), and Staff 17 (RCC) on 10/15/24 at 1:45 pm. They acknowledged the findings.2. Resident 6 was admitted to the facility in 08/2024 with diagnoses including hypertension. The resident's MARs, dated 09/01/24 through 10/14/24, physician's orders, and progress notes, dated 09/17/24 through 10/14/24, were reviewed.Resident 6 had a physician's order for indapamide (for hypertension). On 10/15/24 at 1:45 pm, Staff 1 (ED) confirmed that there were issues with obtaining the medication and the facility had not been able to administer it. The following inaccuracies were identified on the MARs: * Staff initialed the MAR on 12 out of 34 days that the indapamide had been administered; and* There were blanks on the MAR on 09/14/24 and 09/15/24 relating to the indapamide.The need to ensure MARs were accurate was discussed with Staff 1, Staff 2 (Region Nurse Consultant), Staff 3 (Director of Health Services), and Staff 17 (RCC) on 10/15/24 at 1:45 pm. They acknowledged the findings. 3. Resident 7 was admitted to the facility in 02/2023 with diagnoses including pain and lung disease. The resident's 09/01/24 through 10/14/24 MARs, physician's orders, and progress notes, dated 09/14/24 through 10/14/24, were reviewed and the following inaccuracies were identified: * There were two PRN medications for pain without parameters to direct unlicensed staff on which medication to use first;* Resident 7 had two PRN medications for diarrhea, loperamide and lomotil. There were parameters to direct unlicensed staff for the two separate physician's orders relating to the loperamide, but there were no parameters directing staff on when to administer the lomotil; and * Staff were directed to document resident's pain levels using a numerical pain scale from one to ten on the resident's budesonide (for lung disease), celecoxib (for arthritis), and a Fentanyl patch (for pain). Staff documented "[Not applicable]" on multiple occasions.The need for resident-specific parameters and clear instruction for unlicensed staff was discussed with Staff 1 (ED), Staff 2 (Region Nurse Consultant), Staff 3 (Director of Health Services), and Staff 17 (RCC) on 10/15/24 at 1:45 pm. They acknowledged the findings.

Based on interview and record review, it was determined the facility failed to implement an acuity based staffing tool (ABST) that met the regulation. Findings include, but are not limited to:Review of the current census revealed not all facility residents were entered into the ABST and multiple residents had not been reviewed or updated quarterly.No staffing concerns were identified.The need to ensure all residents were entered into the tool and reviewed no less than quarterly was discussed with Staff 1 (Executive Director) on 07/23/24. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure pre-service orientation and dementia care training had been completed prior to staff providing direct care to residents, for 4 of 4 newly-hired caregiving staff (#s 7, 8, 10, and 11). Findings include, but are not limited to:Review of the facility's training records on 07/23/24 indicated the following:Staff 7 (MT), hired 3/20/24, Staff 8 (MT), hired 3/18/24, Staff 10 (CG), hired 6/5/24, and Staff 11 (CG) hired 6/7/24, lacked documented evidence they had completed pre-service orientation and pre-service dementia training prior to providing direct care to residents.The training program and requirements were discussed with Staff 1 (Executive Director) on 07/23/24. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure 3 of 4 caregiving staff (#s 7, 10, and 11) demonstrated satisfactory performance in all job duties and been trained in First Aid and abdominal thrust within 30 days of hire. Findings include, but are not limited to:Staff training records were reviewed with Staff 1 (Executive Director) on 07/23/24.There was no documented evidence Staff 7 (MT), hired 03/20/24, Staff 10 (CG), hired 06/05/24, and Staff 11 (CG), hired 06/07/24, had demonstrated competency all job duties. Staff 8 and 11 had no evidence of being trained in First Aid and abdominal thrust.The need to ensure staff had demonstrated competence in all job duties within 30 days of hire and completed First Aid and abdominal thrust training was reviewed with Staff 1 on 07/23/24. She acknowledged the findings.

Based on interview and record review, it was determined the facility failed to ensure fire and life safety instruction was provided to staff on alternate months. Findings include, but are not limited to:Fire and life safety records for 02/2024 through 07/23/24 were reviewed and lacked the following components:* There was no documented evidence fire and life safety training was conducted on alternating months of fire drills.The need to ensure the facility provided fire and life safety instruction to staff on alternate months of fire drills was discussed with Staff 1 (Executive Director ) on 07/23/24 at 3:30 pm. She acknowledged the 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 C302.

Based on observation and interview, it was determined the facility failed to ensure exterior grounds were kept orderly and free of litter and refuse. Findings include, but are not limited to:On 07/23/24 at 1:00 pm, the facility courtyard was toured and the following was observed:* Loose lawn and maintenance tools in multiple areas;* A tall ladder leaned against the building;* Numerous empty pots or pots with dead plants were scattered throughout;* Black trash bags filled with dead plant matter;* A garden hose laid across the sidewalk, causing a potential tripping hazard;* The wooden seat of a sitting bench was rough and had numerous splintered areas; and* Pet feces was observed in the grass in multiple areas.The need to ensure facility grounds were kept orderly and free of litter and refuse was observed and discussed with Staff 1 (Executive Director) on 07/23/24 at 4:00 pm. She acknowledged the findings.

Based on observation and interview, it was determined the facility failed to ensure all interior surfaces and all equipment necessary for the health, safety, and comfort of the residents was kept clean and in good repair. Findings include, but are not limited to:Observations of the facility on 07/23/24 at 1:00 pm revealed the following:* Gouged and scraped doors and/or jambs were observed in the following areas: - Resident rooms 102, 139, 144, 146, and 147; - Doors to courtyard from television room; - Resident laundry room; - Dining room double doors; and - Entrance door to kitchen.* The spa room had a scraped wall corner near the toilet;* The common women's bathroom in the hallway had discolored caulking around the toilet base and an approximate 12-inch split seam in the flooring on both sides of the toilet;* The common men's bathroom in the hallway had caulking missing from a section surrounding the sink basin;* The common men's bathroom, located near the Executive Director's office, had discolored caulking around the toilet base;* The resident laundry room had an accumulation of debris in the sink basin and used paint supplies and roller on the shelf; and* The dining beverage buffet had brown matter and loose debris on the interior of several cabinets.The surveyor toured the environment with Staff 1 (Executive Director) on 07/23/24 at 4:00 pm. She acknowledged the findings.