Orchards Assisted Living

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 a clean and sanitary kitchen in accordance with the Food Sanitation Rules OAR 333-150-000. Findings include, but are not limited to: Observations of the kitchen on 05/12/25 showed the following areas needed cleaning or repair. * Drips, splatters and/or debris were observed under shelves, on top of dry goods, and on the walls throughout the kitchen, dish area and dry storage; * Black discoloration and accumulation were noted along the floor edges, cabinets, baseboards, around the edges of equipment and at the door edges; * Shelving in refrigerators and/or freezer units had spills, debris, orange/white/tan accumulation with dangling pieces, rust and/or chipped shelf coating. Items stored on lower shelves had brown splatters on the outside of the container/bags. Puddles of water with green clumps in the water were noted at the edges of shelving in the walk in freezer; * Metal baseboard along outside of the walk in was pulling away from the wall; * Shelving in the dry storage and additional areas of the kitchen, had spills, debris, dangling debris and/or light colored accumulation. The shelving units in the dry storage additionally had multiple stickers on shelves that were partially peeling and had dark dust/dirt collected along the surface of the stickers; * Four baking spatulas were chipped, cracked, stained or had missing pieces of rubber; * Chipped shelves were noted under the steam table and under the drink station with exposed particle board; * Paper goods storage area had debris under the shelves and on top of a large plastic storage bin; * Clean pans and plastic bins were stored upside down, there was debris noted in the edges of the pans and bins; * Spills/splatters along the back edges and cage of the stand mixer; * Drains throughout the kitchen had debris, food and/or garbage in the bottom of the drains; * Debris and splatters on the outside of the warming drawer, stove doors, handles and sides; * Significant dust/debris accumulation to the ceiling and light fixtures by the grill/stove; and * Flooring throughout the kitchen had dark black/gray stains of varying sizes. The need to ensure the kitchen was kept clean and in good repair was discussed with Staff 1 (Administrator) and Staff 2 (Dietary Manager) on 05/12/25. The staff acknowledged the findings.

1. We immediately addresed the areas of noted concern druing the visit and either have them handled or on scheduled to be handled. 2. We re-vamped the daily, weekly, monthly cleaning logs both for the kitchen and the maintenance specific cleaning logs to ensure all areas of the kitchen were addressed. We added additional items to be cleaned into a twice weekly schedule as the once weekly was not enough. 3. Cleaning will be evaluated per schedule (daily, weeky, monthly, etc) with walks throughs of the kitchen. If we find that something is needed more often then we will increase the cleaning of that particular task. 4. Dietary Manager, Maintenance Director and Administrator will ensure that the corrections are completed and monitored for on going compliance.

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, 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: 1. The kitchen was toured on 08/17/23. a. The following areas needed cleaning: * There was dust on the top of the free-standing refrigerator and on the top of the ice machine; * The top shelf above the steam table and the top of the infrared food warmer had dust build up; * There was dried food debris around the guides on the top of the plate warmer; * There was black debris on the metal trim along the bottom of the steam table cabinet; * There was dried debris around the plate that mounted the can opener to the prep counter; * There was dust debris on the cutting board rack and the shelf; * There was dried debris in a utensil drawer on a prep counter near the handwash sink; * There was black debris in and around the floor drain under the warewasher; * There was debris on the shelving and plumbing below the warewasher area, and on the InSinkErator control box; * There was black debris build up in the mop basin; * The grills on the exhaust fans in the walk-in refrigerator had dust build up; * A floor fan in the dry storage room had dust debris on the fan blade and grill; * The cadet heater in the dry storage room had dust build up on the grill; * The ceiling air return grill had dust/lint build up; and * Walls, baseboard and floors had splatter and debris build up below the handwash sink, above the mop basin, under the three-compartment sink and above and below the warewashing unit and counters. b. The following areas needed repair: * There were open, unsealed ceiling tile areas in the dry storage room and above the mop basin; * Laminate was separating or missing from shelves in the beverage counter cabinet and steam table cabinet, exposing bare wood and creating an uncleanable surface; and * The door to the dry storage room was gouged, exposing bare wood and creating an uncleanable surface. c. There were several dented cans of food products in the dry storage room. 2. Meal service in the dining room was observed on 8/17/23 from 4:30 - 5:00 pm. One server was observed touching the door handle and the entry door to the kitchen, and using a pen (which s/he stored behind his/her ear) and a note pad to take resident meal orders without washing his/her hands or replacing his/her gloves prior to handling beverages and dinner plates for the residents. This created the potential for the spread of infectious diseases or foodborne illnesses. The areas needing cleaning and repair, and the need to ensure safe food handling practices was reviewed with Staff 1 (Executive Director) and Staff 2 (Dining Services Director) on 08/17/23. They acknowledged the findings.

1. a. In regards to cleaning - we have immediately addressed the areas of noted concern during the visit and are getting the areas clean. b. In regards to repairs - the repairs have been made or items ordered so that the repairs could be completed in a timely manner. c. In regards to dented cans - they have been removed. All staff immediately notified that if they find a dented can while putting them away to put aside so they are not used. -In regards to the server touching door handle, using pen stored behind ear and taking resident's orders without washing hands or replacing gloves prior to handling beverages/dinner plates - a training was held by the Dining Services Director on proper handwashing. 2. a. Re-vamped cleaning logs for the kitchen and added cleaning logs spefically for maintenance to address some of those areas. b. Maintenance kitchen logs created to look over the ktichen and find areas that are in need of repair. c. Dining Services Director will do weekly can inspections to ensure that there are no dented cans. -We have ordered aprons for all servers to wear and they will have hand sanitzer in their aprons to use frequently. In addtion  sanitizing stations have been added to ease of use by both the in/out door of the kitchen.  In addtion the door going into the kitchen has been made so it can swing open rather than having to touch the handle to open it. 3. a. The cleaning logs were re-vamped to show daily, weekly and monthly tasks for both kitchen staff and the maintenance specific tasks. b. Maintenace will be doing weekly walk through of the kitchen to look for repairs and fix as needed. c. Dininger Sevices Manager will go thru the cans weekly to make sure that no dented cans are being used. -Periodic checks will be done to ensure that the servers are handwashing/sanitzing between taking orders/touching stuff and handling beverages/dinner plates. 4.  Dietary Manager/Administrator will be responsible to make sure that the cleaning and reapirs are being done, cans are not dented and servers are washing hands properly.  Maintenance Director will also help over see the repair areas along with Dining Manager and Administrator.

The findings of the kitchen inspection, conducted 08/17/23, 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 08/17/23, conducted on 01/31/24, 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.

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 10/04/2022.  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 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

Based on interview and record review, it was determined the facility failed to ensure new move in evaluations contained all required elements for 1 of 1 sampled resident (# 4) whose move-in evaluation was reviewed.  Findings include, but are not limited to: Resident 4 was admitted to the facility in 03/2022 with diagnoses including diabetes. Review of Resident 4's new move-in evaluations, dated 02/10/22 and 02/28/22 revealed the evaluation lacked the following elements: * Memory, orientation and decision making abilities; * Transportation; * Indicators of nursing needs including potential for delegated tasks; * History of dehydration or unexplained weight loss or gain; and * Environmental factors that impact the resident's behavior including, but not limited to noise, lighting and room temperature. The need to ensure all required elements were included in the new move-in evaluation was discussed with Staff 1 (ED), Staff 2 (VP of Clinical Operations/RN) and Staff 4 (LPN) on 04/26/22. They acknowledged the findings.

1.  Trained our RCCs who do the evaluations on what reqiured elements are needed in the move in evaluation.  Given them a list (taken directely from the CBC forms on line so they can refer to them for reference as well as the OAR. 2. We  have updated our move in evaluation to reflect all of the required elements. 3. This will be reviewed with each new move in. 4. The Administrator will be responsible for this ensuring the corrections are completed/monitored. .

Based on interview and record review, it was determined the facility failed to ensure delegation and supervision of special tasks of nursing care were completed in accordance with Oregon State Board of Nursing (OSBN) Division 47 rules, for 1 of 1 sampled resident (#4) who received insulin injections by unlicensed facility staff. Findings include, but are not limited to: During the acuity interview on 04/25/22, Resident 4 was identified to be administered insulin injections by non-licensed staff. Initial delegation records for Staff 9, 11 and 16 (MTs), reviewed on 04/26/22, lacked documentation in the following areas: * An RN assessment of the resident's condition; * How frequently the client should be reassessed by the RN, including rationale; and * That the RN took responsibility for delegating tasks and ensured supervision would occur for as long as the RN was supervising performance. Periodic inspection, supervision and reevaluation of delegation records were reviewed for Staff 9 (MT), and lacked documentation in the following area: * An RN assessment of the resident's condition to determine that the diabetic condition remained stable and predictable. The need to ensure all staff who administered insulin injections were appropriately delegated in accordance with OSBN Division 47 Rules was discussed with Staff 1 (ED) and Staff 2 (VP of Clinical Operations/RN) on 04/26/22. They acknowledged the findings.

1.  Reviewed with the RN what is required with each delegation.  All current delegations updated to new forms. 2.  Updated Delegation forms to reflect all required information. 3. This will be evaluated with each new delegation. 4. RN, Regional Nurse and Administrator will be responsible for ensuring the correctionsa are completed/monitored.

Based on interview and record review, it was determined the facility failed to provide fire and life safety instruction to staff on alternating months from fire drills. Findings include, but are not limited to: Fire and life safety records, reviewed for the months between 08/2021 and 03/2022, revealed that fire and life safety instructions were not provided to staff on alternating months from the fire drills. In an interview on 04/25/22, Staff 7 (Maintenance Director) reported the facility had not been providing fire and life safety instructions to staff except for when fire drills were completed. The need to ensure fire and life safety instructions were provided to staff on alternate months from fire drills was discussed with Staff 1 (ED) and Staff 2 (VP of Clinical Operations/RN) on 04/25/22.  They acknowledged the findings.

1.  A fire and life safety training was done in April. 2.  A calander will be impleted to show which months are fire drills (and what shift) and which months are fire and life safety training (with the topic). 3. This will be evaluated quarterly to ensure the proper training is being completed. 4. The Maintenance Director and Administrator will be responsbile for enusring the corrections are completed/monitored.

Based on observation and interview, it was determined the facility failed to ensure the electric fireplace did not exceed 120 degrees Fahrenheit (F) in a location that was subject to incidental contact by residents. Findings include, but are not limited to: A tour of the facility on 04/25/22 revealed the following: An electric fireplace located on the second floor of the facility was turned on by the surveyor. The cover of the heating element of the fireplace reached a temperature above 120 degrees F. The need to ensure the cover of the electric fireplace did not reach above 120 degrees F was discussed with Staff 1 (ED), and Staff 8 (Director of Operations). They acknowledged the findings. On 04/25/22, Staff 1 notified the surveyor the electric fireplace had been disabled. They surveyor confirmed the electric fireplace was disabled on 04/25/22 at 3:10 pm.

1. The fire place was immediately turned off at the electric panel when this was brought to our attention. 2. A sign has been placed by the electrical panel to not turn them on again.  Maintenace has added the task to his monthly routine items to check that it is still turned off at the electric planel. 3. Monthly. 4. The Maintenance Director and Administrator will ensure that the corrections are completed and monitored.

The findings of the Change of Ownership survey, conducted 04/25/22 through 04/26/22, 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 for 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 CG: caregiver cm: centimeter ED: Executive Director F: Fahrenheit HH: Home Health LPN: Licensed Practical Nurse MA:          Medication Aide MAR: Medication Administration Record MCC: Memory Care Community mg: milligram ml: milliliter MT: Medication Technician OT: Occupational Therapist PT: Physical Therapist PRN: as needed qd: every day or daily qid: four times a day QI:     quality improvement RCC:       Resident Care Coordinator RN:     Registered Nurse TAR:     Treatment Administration Record tid:           three times a day

The findings of the revisit to the re-licensure survey of 04/26/22, conducted 08/01/22 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.