Avamere at Sandy.

“Based on observation, interview, and record review, 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 C295 and C513. Refer to C295 and C513 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:”

“Based on the resident evaluation performed before move-in, an initial service plan must be developed before move-in that reflects the identified needs and preferences of the resident. (b) The initial service plan must be reviewed within 30-days of movein to ensure that any changes made to the plan during the initial 30- days, accurately reflect the resident's needs and preferences. (c) Staff must document and date adjustments or changes as applicable. (4) QUARTERLY SERVICE PLAN REQUIREMENTS. (a) Service plans must be completed quarterly after the resident moves into the facility. (b) The quarterly evaluation is the basis of the resident's quarterly service plan. (c) If the resident's service plan is revised and updated at the quarterly review, changes must be dated and initialed, and prior historical information must be maintained. This Rule is not met as evidenced by: Based on observation, interview, and record review, it was determined the facility failed to ensure service plans were reflective of residents' current care needs, provided clear direction regarding the delivery of services, and was implemented for 1 of 3 sampled residents (#1) whose service plans were reviewed. Findings include, but are not limited to: Resident 1 moved into the facility in 02/2019 with diagnoses including Alzheimer’s disease, psychotic disturbance, and history of malignant neoplasm of breast. Observations were made of the resident's care from 12/10/24 through 12/12/24. Interviews with staff were conducted and the current service plan, dated 09/03/24, was reviewed. The following was identified: Resident 1's service plan was not reflective of his/her current needs, lacked clear direction, and/or was not implemented in the following areas: * For staff to wait for resident to participate in ADL care and to re-approach as needed; * Frequency of toileting and incontinent care; * Social and physical engagement including staff to take resident on walks throughout the day; * Consistent implementation of severe weight loss interventions; * Consistent implementation of fall risk interventions; * Behavioral interventions; * When to use assistive devices including his/her manual wheelchair; and * Residents ability to self-transfer. The need to ensure service plans were reflective of the residents' current needs, provided clear direction regarding the delivery of services, and was implemented was discussed with Staff 1 (ED), Staff 2 (Memory Care Director), Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings. 1.Resident #1's service plan has been updated to include all required components and to accurately reflect the resident's current status, needs and preferences with clear direction for care staff. A Service plan audit has been completed for all residents to ensure current care needs are reflective and provide clear instructions to care staff. 2. Education conducted with care staff on following interventions outlined in service plans and reporting care discrepancies with residents care needs and the service plan. A 'POC Errors/Issues' form was implemented for care staff to document discrepancies between residents service plan and care needs. Care staff have been trained to submit this form to the administrator to review when completed. 3. Service plans will be reviewed and updated upon admission, at 30 days, quarterly and with significant change of condition. 'POC Errors/Issues' forms will be reviewed, and appropriate service plan updates will be made as needed. 4. The Arbor Administrator and Executive Director will be responsible for maintaining this system. OAR 411-054-0036 (1-4) Service Plan: General (1) If the resident has a Person-Centered Service Plan pursuant to 411- 004-0030, the facility must incorporate all elements identified in the person centered service plan into the resident's service plan. (2) SERVICE PLAN.The service plan must reflect the resident's needs as identified in the evaluation and include resident preferences that support the principles of dignity, privacy, choice, individuality, and independence. (a) The service plan must be completed: (A) Before resident move-in, with updates and changes as appropriate within the first 30-days; and (B) Following quarterly evaluations. (b) The service plan must be readily available to staff and provide clear direction regarding the delivery of services. (c) The service plan must include a written description of who shall provide the services and what, when, how, and how often the services shall be provided. (d) Changes and entries made to the service plan must be dated and initialed. (e) When the resident experiences a significant change of condition the service plan must be reviewed and updated as needed. (f) A copy of the service plan, including each update, must be offered to the resident or to the resident's legal representative. (g) The facility administrator is responsible for ensuring the implementation of services. (h) Changes to the service plan, including updates due to a significant change of condition and quarterly updates must be reflected in the facility’s ABST care elements. (3) SERVICE PLAN REQUIREMENTS BEFORE MOVE-IN. (a) Based on the resident evaluation performed before move-in, an initial service plan must be developed before move-in that reflects the identified needs and preferences of the resident. (b) The initial service plan must be reviewed within 30-days of movein to ensure that any changes made to the plan during the initial 30- days, accurately reflect the resident's needs and preferences. (c) Staff must document and date adjustments or changes as applicable. (4) QUARTERLY SERVICE PLAN REQUIREMENTS. (a) Service plans must be completed quarterly after the resident moves into the facility. (b) The quarterly evaluation is the basis of the resident's quarterly service plan. (c) If the resident's service plan is revised and updated at the quarterly review, changes must be dated and initialed, and prior historical information must be maintained. This Rule is not met as evidenced by:”

“Based on observation, interview, and record review, it was determined the facility failed to ensure residents who had changes of condition were monitored consistent with his or her evaluated needs through resolution and resident specific interventions were determined and implemented for 1 of 3 sampled residents (#1) who experienced changes of condition including severe weight loss. Findings include, but are not limited to: Resident 1 moved into the facility in 02/2019 with diagnoses including Alzheimer’s disease, psychotic disturbance, and history of malignant neoplasm of breast. The resident was admitted to hospice in 02/2024. The resident's record was reviewed, including the 09/03/24 service plan, Interim Service Plans (ISPs), Nutritional Assessments, significant change of condition documentation, dated 06/20/24 through 11/18/24, Progress Notes, and Incident Reports. Observations were made and interviews were conducted. The following changes of condition were identified: a. On 05/16/24, an RN assessment was completed due to a significant change of condition. The assessment noted the resident’s weight to be 140.3 pounds on 04/19/24 and 114.2 pounds on 05/16/24, which constituted a severe weight loss of 26.1 pounds or 18.6% of his/her total body weight. The assessment identified the following interventions: * Implement fortified meals; * Continue to provide nutritional shakes three times daily; * Staff to physically assist with eating; and * Get resident up and seated in the dining room for all meals. The following weights were documented in the resident record: * 06/15/24 – 122.6 pounds; * 06/21/24 – 119.4 pounds; * 06/28/24 – 117.8 pounds; * 07/05/24 – 116.5 pounds; * 07/12/24 – 116.0 pounds; * 07/19/24 – 113.2 pounds; * 08/02/24 – 113.2 pounds; * 08/10/24 – 112.5 pounds; * 08/23/24 – 110.0 pounds; * 09/06/24 – 108.6 pounds; * 09/27/24 – 107.0 pounds; * 10/04/24 – 105.1 pounds, and a hospice note indicated to discontinue weekly weights on 10/11/24; * 11/04/24 – 99.1 pounds; and * 12/12/2024 – 99.5 pounds. RN assessments, dated 06/27/24 through 11/18/24, identified the following interventions: * Encourage resident to have meals in the front dining room; * May try finger foods for a couple weeks; * Weekly weights; * Avoid sitting resident at dining room table until food is ready and placed at his/her seat; * May leave health shake with resident; * If resident has poor intake, offer finger foods for him/her to carry; * Offer food resident enjoys; * Staff to escort resident to all meals; * Full feeding assist as the resident allows; * Verbal and non-verbal cueing during meals; * Offer additional choices for food options; * Monitor oral intake weekly; and * Offer food/snack in between meals and when s/he wakes up. On 12/11/24, the resident was observed to be offered a nutritional shake and a piece of chocolate, and was noted to consume approximately 75% of his/her lunch with staff prompting, cueing, and assisting with feeding. Resident 1 continued to experience weight loss and the facility identified interventions, however there was no documented evidence the interventions were monitored for effectiveness. On 12/11/24 at 2:55 pm, Staff 2 (Memory Care Director) confirmed there was no documented evidence that nutritional shakes, finger foods, or snacks were provided to Resident 1. There was no documented evidence that fortified meals and finger foods were provided and the interventions including to provide a nutritional shake three times daily, nutritional shakes could be left with the resident, full assistance with feeding, monitoring oral intake weekly, and that food/snacks to be offered between meals or when s/he woke up, were monitored consistent with his/her evaluated weight loss. b. The resident was at risk for falls and ISPs identified the following interventions: * “If staff [do] not see [the resident] in the common area…go check on [him/her] and make sure [s/he] is not in someone else’s room”; and * “Hospice RN is ordering an x-ray.” The resident experienced falls on the following dates: * 10/12/24: Fall in another residents room; * 10/12/24: Unwitnessed fall in common area; * 10/14/24: Unwitnessed fall in dining room; and * 12/01/24: Unwitnessed fall in hallway outside of room 108. There was no documented evidence resident specific interventions were determined or that the resident was monitored consistent with his/her evaluated needs. c. On 10/12/24, the resident’s record identified s/he was hit on the head with a door and there was no documented evidence of resident specific interventions or that the condition was monitored, through resolution. Resident 1 was observed throughout the survey without injury to his/her face or head. The need to ensure residents who experienced changes of condition were monitored consistent with their evaluated needs through resolution and resident specific interventions were determined and implemented was discussed with Staff 1 (ED), Staff 2, Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings.”

“Based on observation and interview, it was determined the facility failed to establish and maintain effective infection prevention and control protocols to provide a safe and sanitary environment during meal service for multiple unsampled residents and 1 of 2 sampled residents who received ADL care. Findings include, but are not limited to: a. Lunch service was observed on 12/10/24 through 12/12/24. On 12/10/24 during lunch service, staff were observed to assist residents without use of a protective barrier and hand hygiene was not completed in between assisting residents. On 12/11/24 during lunch service, Staff 8 (CG) and Staff 15 (CG) were observed to serve meals, provide meal assistance to multiple residents simultaneously, refill beverages, touch multiple resident’s assistive equipment, and provide escorts for residents who were non-ambulatory, without performing hand hygiene. b. On 12/10/24 at 12:06 pm, while providing toileting assistance for Resident 1, Staff 15 (CG) did not change gloves between touching soiled incontinent supplies and the resident’s clean clothes. Staff 15 did not complete hand hygiene after assisting with toileting and before assisting other residents. The need to ensure universal precautions for infection control were exercised, including appropriate hand hygiene while serving meals and providing care services to the residents, was discussed with Staff 1 (ED), Staff 2 (Memory Care Director), Staff 4 (Director of Health Services, LPN), and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 3:23 pm. They acknowledged the findings.”

“Based on observation and interview, it was determined the facility failed to ensure the environment was maintained in clean and good repair. Findings include, but are not limited to: Observations of the facility on 12/11/24 through 12/12/24 showed the following areas in need of cleaning or repair: * Scrapes and dings were noted on doors or door frames at rooms 101 and 107; * A large gouge/scrape on the wall in living room across from Administrator’s office; * Stains on carpet throughout living room; * Multiple light fixtures throughout the memory care had insects and/or debris in them; and * There was a strong, pervasive urine odor in the hallway outside of Room 105. The areas in need of cleaning and repair were shown to and discussed with Staff 2 (Memory Care Director) and Staff 9 (Plant Operations) on 12/12/24 at 11:30 am. They acknowledged the 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 C260 and C270. Refer to C260 and C270 OAR 411-057-0160(2b) Compliance with Rules Health Care (b) Health care services provided in accordance with the licensing rules of the facility. This Rule is not met as evidenced by:”

“Based on interview and record review, it was determined the facility failed to ensure individualized nutrition and hydration plans for each resident were developed and included in the service plans for 2 of 3 sampled residents (#s 1 and 2) residing in the MCC. Findings include, but are not limited to: Resident’s 1 and 2’s clinical record including current service plans were reviewed during the survey and identified the following: • Both residents had a history of weight loss; and • Service plans lacked an individualized nutrition and hydration plan. The need to develop an individualized nutrition and hydration plan for the resident and include the information in the resident's service plan was reviewed with Staff 1 (ED), Staff 2 Memory Care Director), Staff 4 (Health Services Director, LPN) and Staff 6 (Vice President of Clinical Services) on 12/12/24 at 11:57 am. They acknowledged the findings.”

“based on their activity evaluation. The plan must reflect the resident ' s activity preferences and needs. (C) A selection of daily structured and non-structured activities must be provided and included on the resident ' s activity service or care plan as appropriate. Daily activity options based on resident evaluation may include but are not limited to: (i) Occupation or chore related tasks; (ii) Scheduled and planned events (e.g. entertainment, outings); (iii) Spontaneous activities for enjoyment or those that may help diffuse a behavior; (iv) One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); (v) Spiritual, creative, and intellectual activities; (vi) Sensory stimulation activities; (vii) Physical activities that enhance or maintain a resident ' s ability to ambulate or move; and (viii) Outdoor activities. This Rule is not met as evidenced by: Based on interview and record review, it was determined the facility failed to evaluate and develop individualized activity plans for 3 of 3 sampled residents (#s 1, 2, and 3) whose activity plans were reviewed. Findings include, but are not limited to: a. Resident 1, 2, and 3’s records were reviewed during the survey. There was no documented evidence an activity evaluation had been completed and including the follow required information: * Past and current interests; * Current abilities and skills; * Emotional and social needs and patterns; * Physical abilities and limitations; * Adaptations necessary for the resident to participate; and * Identification of activities for behavioral interventions. b. Resident 1, 2 and 3 lacked an individualized activity plan that was based on their activity evaluation and reflected activity preferences and needs including daily structured and non-structured activities that include but are not limited to the following: * Occupation or chore related tasks; * Scheduled and planned events (e.g. entertainment, outings); * Spontaneous activities for enjoyment or those that may help diffuse a behavior; * One to one activities that encourage positive relationships between residents and staff (e.g. life story, reminiscing, music); * Spiritual, creative, and intellectual activities; * Sensory stimulation activities; * Physical activities that enhance or maintain a resident 's ability to move or ambulate; and * Outdoor activities. On 12/12/24 at 11:57 am, the lack of an activity evaluation and individualized activity plan was discussed with Staff 1 (ED), Staff 2 Memory Care Director), Staff 4 (Health Services Director, LPN) and Staff 6 (Vice President of Clinical Services). They acknowledged the findings.”

“The findings of the kitchen inspection, conducted 08/20/24, 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, and OARs 411 Division 57 for Memory Care Communities. The findings of the kitchen inspection, conducted 08/20/24, 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, and OARs 411 Division 57 for Memory Care Communities.”

“The findings of the kitchen inspection, conducted 07/20/23, 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 kitchen inspection, conducted 07/20/23, 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 revisit to the kitchen inspection of 07/20/23, conducted 09/22/23, 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. The findings of the first revisit to the kitchen inspection of 07/20/23, conducted 09/22/23, 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.”

“Based on observation, interview and record review, it was determined the facility failed to maintain the kitchen in good repair and in a sanitary manner, and to ensure meals were served at appropriate temperatures and were palatable, in accordance with the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: On 07/20/23 at 10:50 am, observations of the primary kitchen located in assisted living identified the following deficiencies: a. An accumulation of food spills, splatters, loose food, dirt, and dust on or underneath the following: * Upright refrigerator (near the entrance of the kitchen) had yellow colored liquid spilled on the lower shelf; * Southbend oven had an accumulation of food matter buildup on the inside of the oven; * Floor fan had a buildup of dirt and dust debris that was blowing directly on clean dishes; and * Metal storage rack (near the warewash machine) that stored clean dishes had a buildup of dirt and dust debris. b. The following areas were found in need of repair: * Montague Grizzly oven was not operable; * Grill next to the oven was not operable; and * Walk-in freezer door had missing piece of gasket which caused ice buildup around the freezer door. c. All staff working in the kitchen failed to have documented evidence of valid Oregon Food Handler cards. d. Observations of the kitchenette located in the MCC identified the following deficiencies: * Freezer pull out drawer had a buildup of white, pink and brown food matter on the lower shelf; * Chemicals stored in unsecured cabinet above the stove; * Spills, dirt and debris buildup inside multiple cabinets and drawers; and * Improper storage of food items in cabinets (open bags of bread). The kitchen was toured and the need to ensure the kitchen was maintained in accordance with Oregon food sanitation rules was discussed with Staff 1 (Director of Quality and Compliance) and Staff 2 (Director of Culinary Services) at 1:02 pm. They acknowledged the above findings. Based on observation, interview and record review, it was determined the facility failed to maintain the kitchen in good repair and in a sanitary manner, and to ensure meals were served at appropriate temperatures and were palatable, in accordance with the Food Sanitation Rules, OAR 333-150-000. Findings include, but are not limited to: On 07/20/23 at 10:50 am, observations of the primary kitchen located in assisted living identified the following deficiencies: a. An accumulation of food spills, splatters, loose food, dirt, and dust on or underneath the following: * Upright refrigerator (near the entrance of the kitchen) had yellow colored liquid spilled on the lower shelf; * Southbend oven had an accumulation of food matter buildup on the inside of the oven; * Floor fan had a buildup of dirt and dust debris that was blowing directly on clean dishes; and * Metal storage rack (near the warewash machine) that stored clean dishes had a buildup of dirt and dust debris. b. The following areas were found in need of repair: * Montague Grizzly oven was not operable; * Grill next to the oven was not operable; and * Walk-in freezer door had missing piece of gasket which caused ice buildup around the freezer door. c. All staff working in the kitchen failed to have documented evidence of valid Oregon Food Handler cards. d. Observations of the kitchenette located in the MCC identified the following deficiencies: * Freezer pull out drawer had a buildup of white, pink and brown food matter on the lower shelf; * Chemicals stored in unsecured cabinet above the stove; * Spills, dirt and debris buildup inside multiple cabinets and drawers; and * Improper storage of food items in cabinets (open bags of bread). The kitchen was toured and the need to ensure the kitchen was maintained in accordance with Oregon food sanitation rules was discussed with Staff 1 (Director of Quality and Compliance) and Staff 2 (Director of Culinary Services) at 1:02 pm. They acknowledged the above findings. C240 a. 1) Facility staff immediately did a deep clean of all kitchen and dining room areas including but not limited to all areas noted in the SOD. 2) Plan of correction includes a Dietary Audit Sheet to be completed daily by dietary staff.  If an items needs to be referred to maintenance or housekeeping for deeper cleaning, a referral will be made through the maintenance workflow system, TELS with follow up by the Dietary Services Manager.  Inservice with all relevant employees completed on cleaning and sanitation protocols.  Protocols all posted in the kitchen area for reference. 3) Dietary Service Manager will audit weekly and provide additional inservice and training as needed. 4) Executive Director is responsible to see that the corrections are completed and monitored. b. 1) Non-functioning Montague Grizzly oven and grill were removed from the kitchen. Gasket for freezer is on order.  Follow up email sent to vendor for estimated delivery date. Work order placed with maintenance for cabinet veneer door replacement. 2) Plan of correction includes weekly walkthrough between DSM, Maintenance Director and ED and any areas of improvement needed, will be placed on a workorder for repair and/or removal. 3) Weekly walkthroughs will be completed. 4) Executive Director is responsible to see that the corrections are completed and monitored. c. 1) DSM immediately reached out to all kitchen staff to get copies of all Food Handler cards, that were not found in the personel files.  All are current and up to date. 2) Plan of correction includes audits conducted of certifications for all new hires and renewals for exisiting employees, using the training grid. 3) Review training grid and certifications at monthly CQI meeting. 4) Executive Director is responsible to see that the corrections are completed and monitored. d. 1) Deep clean of kitchenette completed, cabinets were locked that contained chemicals, personal items were moved to another secured area. 2) Plan of correction includes an Audit Sheet to be completed by unit staff.  If an item needs to be referred to maintenance or housekeeping for deeper cleaning, a referral will be made through the maintenance workflow system, TELS with follow up by the Dietary Services Manager.  Inservice with all relevant employees completed on cleaning, sanitation and chemical safety protocols. 3) Dietary Service Manager will audit weekly and provide additional inservice and training as needed. 4) Executive Director is responsible to see that the corrections are completed and monitored. C240 a. 1) Facility staff immediately did a deep clean of all kitchen and dining room areas including but not limited to all areas noted in the SOD. 2) Plan of correction includes a Dietary Audit Sheet to be completed daily by dietary staff.  If an items needs to be referred to maintenance or housekeeping for deeper cleaning, a referral will be made through the maintenance workflow system, TELS with follow up by the Dietary Services Manager.  Inservice with all relevant employees completed on cleaning and sanitation protocols.  Protocols all posted in the kitchen area for reference. 3) Dietary Service Manager will audit weekly and provide additional inservice and training as needed. 4) Executive Director is responsible to see that the corrections are completed and monitored. b. 1) Non-functioning Montague Grizzly oven and grill were removed from the kitchen. Gasket for freezer is on order.  Follow up email sent to vendor for estimated delivery date. Work order placed with maintenance for cabinet veneer door replacement. 2) Plan of correction includes weekly walkthrough between DSM, Maintenance Director and ED and any areas of improvement needed, will be placed on a workorder for repair and/or removal. 3) Weekly walkthroughs will be completed. 4) Executive Director is responsible to see that the corrections are completed and monitored. c. 1) DSM immediately reached out t”

“Based on observation, interview and record review, 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 C 240. Based on observation, interview and record review, 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 C 240. see C 240 see C 240 There are no detail notes for this visit.”