08/06/1998 - Packet r
CITY OF TIGARD
OREGON
COMMUNITY HOUSING
TASK FORCE MEETING
at
CITY OF TIGARD
13125 SW HALL BLVD
Red Rock Conference Room
Thursday, August 6, 1998
1:00 pm to 3:00 pm
AGENDA
I. Self introductions.
II. Approval of July 9, 1998 meeting minutes.
III. Work session.
A. Discussion of Social Care Facilities.
1. Scope of ordinance re: Social Care Facilities
2. Substantive provisions re: Social Care Facilities
3. Future actions re: Social Care Facilities
B. Other.
IV. Meeting schedule confirmation.
V. Adjourn.
is\bldg\david\commhous\agen&s\agd08O6.doc
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 TDD (503)684-2772
TIGARD MUNICIPAL CODE
The proposed changes to the Tigard Municipal Code include"Social Care Facilities"
within the definition of"dwelling" for purposes of property maintenance regulations. If
the proposed change is adopted, Tigard nursing, assisted living and residential care
facilities likely would be subject to the Tigard regulations related to building structural
requirements as well as state administrative rules on this subject.
Our argument that Tigard should not include Social Care Facilities within the scope of
municipal regulation should focus on the following:
• In several areas cases the Tigard rules conflict with existing State regulation.
• State regulation of long term care facilities is already extensive and provides
adequate protection for residents. (why the need to include long term care facilities
in local regulation?)
• Long term care facilities are unique. Long term care facilities are different from
apartments and hotels in that they provide not only a place to live but also medical
care. The Tigard rules do not distinguish between strictly residential dwelling units
and units occupied by persons with medical needs.
• Too complicated for regulators and consumers to keep track of duplicative local and
state regulation and also requires duplicative inspections.
• Nursing Facilities continuously licensed since January 1, 1992 and RCFs licensed
since 1994 are exempt from some state regulations. Requiring compliance with
Tigard regulations might place many of them in immediate noncompliance.
Conflicts
Problem. Tigard rules require door to exterior of dwelling unit to permit opening from
inside without use of key or any special knowledge or effort. (14.16.180) Nursing
facilities may not be able to do this as resident wandering is a concern. The State nursing
facility rules allow exit/entrance doors to have electro-magnetic locks that automatically
release in the event of a fire alarm or power failure(411-87-400).
Problem. The Tigard rules require each habitable room to have at least one window that
can be easily opened or another approved device to adequately ventilate the room
(14.16.170). The State nursing facility rules do not require a window to be operable if the
building is designed with an engineered smoke control system. 411-87-400. I don't
know if the smoke control system would qualify as an"approved ventilation device."
Problem. The State nursing facility rules allow one bathtub for every 25 beds that are
not otherwise served by bathing facilities within the residents' rooms. The RCF rules
allow one bath per every 10 residents (411-55-101). The Tigard rules require one bathtub
per floor and at the rate of one for every 12 residents. (modifications available for
individual cases) 14.16.230.
Problem. The Tigard rules require water supplied to sinks,bathtubs and showers to be
heated to at least 120 degrees. 14.16.250. The State nursing facility rules allow the water
to be between 100 and 120 degrees, 411-87-460,or between 110 and 120 for an RCF or
ALF (411-55-131, 411-56-040).
Problem. The Tigard rules require handrails on stairs to be between 30 and 38 inches
from the floor(14.16.150). Is this the right height for Nursing Facilities, RCFs or ALFs?
Are there additional considerations based on nature of residents, who are in wheelchairs,
and staff needs? As noted below, the Tigard rules do not require handrails in corridors.
Problem. The Tigard rules prohibit overcrowding in a dwelling unit and define it to
mean, after the first resident, more than one additional resident for every 150 square feet
of floor area in a habitable room, 14.16.290. Nursing facilities commonly have more
than one bed per room. Don't know if the room size meets the Tigard requirement.
State rules are extensive
Nursing, Assisted Living and Residential care facilities already must comply with the
Oregon Building Code, local building regulations and the Uniform Fire Code (411-87-
020, 411-55-081, 411-56-040).
The State Nursing, Assisted Living and Residential Care Facility rules address virtually
all the same issues addressed in the Tigard Municipal Code. The only relevant areas
where the State does not regulate are as follows:
Address number display
Requirements related to adequate facility structure, roof and exterior walls and
dangerous structures such as application of approved protective coating of
weather-resistant preservative(14.16.140) and prohibition on crumbling
foundations (14.16.130) although these issues are likely regulated by the State
Building Code or the general requirement that facilities be maintained in good
repair.
In addition to other requirements, RCFs, ALFs and Nursing Facilities must submit
construction plans to Oregon Health Division for approval. 411-55-071, 411-87-010.
State rules address unique long term care facility needs (medical as well as
residential issues)
Heat: The nursing facility and RCF rules require a heating system capable of maintaining
a temperature of 75 degrees (411-87-450, 411-55-131)whereas the Tigard rules require
only 68 degrees (14.16.260).
Ventilation: The State NF, ALF and RCF rules contain extensive regulation on
ventilation systems. The Tigard rules do not address it.
Lighting: The Tigard rules are very general and merely require operable light fixtures
and that hallway and stairway lighting have at least one foot candle illumination at
principal points and '/z foot candle elsewhere. 14.16.270. The State NF rules state
specifically that older persons require higher levels of illumination and are much more
sensitive to glare. Lighting fixtures in NF must be designed to minimize glare and must
provide minimum foot candle illumination ranging from 10 to 100. ALF requirements
range from 20 to 50 foot candles(411-56-040).
Sleeping room requirements: The Tigard rules are again very general and require only
that the room be habitable, have appropriate lighting, ventilation, etc. (14.16.280). The
State RCF, NF and ALF rules also contain these requirements but also regulate room
size, allowances between the bed and the wall, room for wheelchair movement, etc.
(411-87-130, 411-55-111, 411-56-040).
The Tigard rules do not require every room to have a window. The RCF, ALF and NF
rules do and require the window to be bigger(10% of floor area v. 6.8%). 411-87-400,
411-55-101, 411-56-040, 14.16.170.
The RCF rules require regular fire drills and an on-going safety program. 411-55-081.
The RCF rules regulate width of corridors. 411-55-101
The NF rules require handrails on all corridors. 411-87-350.
Many more examples related to sanitary kitchen facilities, dining facilities and other
issues not present in a typical apartment building or hotel.
• The State rules are developed to ensure that long term care residents receive quality
care in a safe setting. The Tigard rules improperly treat long term care facilities and
residents the same as apartments or hotels and their residents, who do not have the
same needs.
A5 AN
"CFA UPF�r-MiC-,D A N5V�zT=5 `!3
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ZALTz CAU PZUAXCIXa a1SKMS-ZPJ=ox -4 -V16 %�> A S A Ax.P U� -- r.O NO. 0938-(
. (rl)Pn=zl =KW (X2) KSR.TIPLZ C0xsS7arC=Cx (X3)DA= SuAvrz Corsa
Ci' Vmcnxclms Aim PLAN 0! CaFimc.-Iox XU23:DZXG
Z. YrR0 07/29/93
(AXI CST P7 VIB23t CSR 907n =1t 273MET 10 =11 CITE, XT1tx, ZIP Czar
Xf) ID SLSrOLVa BM%Tt?{rx'1' Cr DZ?ICItTCIU ID YF40 XR'S PL)LX o7 CMWCTIOx (Y.5)
77mI3L (zags MMICIUM MST a= xuaanm IT r= P7UL7nC (LUM C0)t7tZ=M ACTIOX S== X= CK=- CCRVLX
TMG '7l C2 L=c nza mnix xx7w 0LT=) =a JWZ1ta(CZD TO TX= A"ROMATZ DZ?TCZlxC:X) IIATZ
000 X3 TAM x 000
IXZTIaL ccFoaXTZ
This is two story nursing facility vitt
partial besesssnt. 159 bode ars located
at thin facility.
1905 bclstinq Coded used for
ct�acratire surrey
!C 01.2 XZPA 101 B=LX S=: 1 012
Llrz LAY= qoz ETUDAM
Xulldlm caastraction type and balgtt
rests app:opriita of the Life
Safety Cods. 13-1.b.2, I3-i.b.t,
23-3.5.1
®r—
TtLis STAXZ&= is not seat as evidemced try:
^he facility did not amours that tea
building construction type and beight
smote appropriate types of the L1fs
Safety Code.
It was observed during the surrey of
7/23/93 that the facility did not rest
the rvgnirsrsnts due to tb# lack of
protected caaatruc Unprotected
a ural stwel and floor joist& were -
-------------'^----------------------------------—-----------------------------------------------------------------------------
PROVIDrR '3 SIGXAT07it :ITIS (X6) ZA:
..-------------•-------------------------------------------------------------------------------------------------------------------
>Aay deficienC-y statement ending with as asterisk (•) denotes a deficiency which MAY bs oXCused from correcting prcvldi g it is
dstar-Tined that othar safeguards provide sufficient protection to the patients. (See reverse for further instr.:c.icns.) -to
fir --go above are disclosable 90 days following the data of survey wtothar or not a plan of correction is provided. If
do &=Iso are cited, an approved plan of correction is requisite to continued program participation.
--------------------------------------------------------------------------------------------------------------------------
YC201 HCY)L-2567(10-64) If Continuation *toot Page 1 of 1:
I
WwA]C]a= Cr EXALTS AND =W SZ3mCX3 S rOAM An
40== CA= ?IMXCIXC AaICL 377ATION as SO. 0931
(Xl)rTO713Xx XUMM (X2) MULTIPLZ C3SaTRDCTIOa (X3)D= SDRm cc
STA.TXtCC1cT Cr D" CZXNCIX3 An PLAN or CORRXCTZOS A. sunziUC
S. VISC 07/29/93
AAXZ Cr "DVIDat Ot SUMMIit r== A=7=3, CITY, STASS. ZIP CJDX
(X4) 2D SUMK&Xr 6ZLTXKKIfT Or DX7ZCZX!(C22E 1p P74VIDXRrs PLAN Or C7AXXCTIOs (XS)
PXaIX (RACE MrrICIXXCY XUST aX PSXC=XD XT P(721 rMIX (XACS COMU"Iv ACTIOX Si== XX CROSa- Mto
3= 72 1 AMtW OR LEC IDXETZZIISa lZrOMT10t) lu YJ7= ECXD ICA TSX APPRCFRIATZ DXxIC=ffCr) VA
X 012 ( Continued rrosi Paas 1 )
fouad thra oat the structure.
The building is of Type II (1,1,1)
asustruction which can not be over
three stones with a ""';Iota aatomatic
aprinkter s7stem.
X 014 X]PA 101 VZUMAP.Dt X 014
LI?Z SAYX—f C=X STANDARD
Intari.or finish far corridors and
sxltirays, including exposed interior
surfaces of buildings such as fixed or
movable watts, partitions, colt=s and
Ceilings has a flame spread rating of
Class A or Class 2 or less. 13-3.3.1
=12 SVLXZAM is tat net as avidanced by:
facility did not assure that the
interior finish for ceilings was
1.:tact.
It was obsarved an 7/25/93 that many
coiling tiles wsry missing or
penetrated at tbs following locations
tha maintenance office and sbop,
personal office, agar first floor
-44"Ing room in hall by smoke doors,
tslophoae on first floor, near rooms 51
and 61. Ths monalitbic c'siliag text to
the satraacs of the laundry roc= bas a
larpe gash In It..
X 017 NrrA 101 STAMMM: X 017
LITX EA72:7 =2 aTMMA=
Corridors arm separatsd from ass arses
by walls ca=st.-acted with at 1 w t a 20
miauts fire rsaistaacs rating. In
spriaklarod buildings, partitions ars
---------------------------------------------------•-------------------------------------------------------------------------
2( ECXA-2567(10-81) If continuation shoat Page i
Y
AH
AND DISABLED SERVICES DIVISION FORM APPROVED
-----------------------------------------------------------------------------------------------------------------------------
:TION { (X3)DATE SURVEY
{ COMPLETED
} 01/16/98
----------------------------------------
NI
----------------------------- - -------------------------------------------------------------------------------
(X4) ID { SUMMARY STATEMENT OF DEFICIENCIES { ID { PROVIDER'S PLAN OF CORRECTION } (X5)
PREFIX { (EACH DEFICIENCY MUST BE PRECEEDED BY FULL { PREFIX } (EACH CORRECTIVE ACTION SHOULD BE CROSS- }COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) { TAG { REFERENCED TO THE APPROPRIATE DEFICIENCY) { DATE
------------------------------------------------------------------------------------------------------------------------------------
R1533 { 411-55-131(4) (A) RULE: } R1533 { }
{ HEATING/VENTILATING:HOT WATER =4PE.RATU } ( }
(4) (a) In resident areas, hot water } } }
} temperature shall be maintained within ( { }
{ a range of 110 to 120 degrees } } }
Fahrenheit; and } } }
} This RULE is not met as evidenced by: } } }
} The hot water temperature from two } { }
} resident sinks in the ACV was measured ( } }
} above 120 degrees Farenheit. The } } }
} maintenance staff person stated that he } } {
} did not have a thermometer, and did not ( } }
} routinely ckeck water temperatures. } ( }
} During the course of the visit, the } } }
} temperatures were brought down to a } } }
} safe range. This was verified by an } }
} inspection of a professional plumbing } } }
service. ( ( }
R1641 } 411-55-170(2) RULE: } R1641 } }
} ADMISSIONS,SCREENING:ORIENTATION
} (2) Upon admission, the administrator } } }
or his/her delegate must provide an ( } }
} admission orientation that includes an } } }
} explanation of Resident Rights, } } }
} Residential Care Facility Rules, and
} enter into an admission ( } }
}
contract/agreement that explains } } }
}
provider/resident expectations,
} schedule of rates, conditions under
} which rates can be changed and the { ( }
} facility's refund policy and grievance } }
} policy. The facility cannot require the ( } }
} resident to waive any rights. It shall ( ( }
} also include review of the discharge } } }
} policy and explanation of circumstances } ( }
} when the facility will not be able to } } }
} provide care. } }
------------------------------------------------------------------------------------------------------------------------------------
STATE FORM If continuation sheet Page 5 of 11
AH
TMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
TH CARE FINANCING ADMINISTRATION 2567-L
-•--------------------------------------------------------•-----------------------------------------------------------------------
ATEMENT OF DEFICIENCIES { (X1) PROVIDER/SUPPLIER/CLIA { (X2) MULTIPLE CONSTRUCTION { (X3)DATE SURVEY
.ANO PL1 { COMPLETED
! 03105/98
--------- ------------------------------
NAME'OF 'PF
d - -------------------- ----
(X4) ID ( SUMMARY STATEMENT OF DEFICIENCIES { ID I PROVIDER'S PLAN OF CORRECTION 1 (X5)
PREFIX I (EACH DEFICIENCY MUST BE PRECEEDED BY FULL I PREFIX { (EACH CORRECTIVE ACTION SHOULD BE CROSS- {COMPLETION
TAG ! REGULATORY OR LSC IDENTIFYING INFORMATION) { TAG { REFERENCED TO THE APPROPRIATE DEFICIENCY) I DATE
------------------------------------------------------------------------------------------------------------------------------------
F9999 ! MEMO TAG: I F9M ( i
I FINAL OBSERVATIONS I { I
I { I {
! I 1 I
f ! ! 1
I The facility must operate and provide
I services in compliance with all ( { {
I applicable state and local laws, I I {
{ regulations and codes. { ( {
I This REQUIREMENT was not met as { {
I evidenced by: I I {
I OAR 411-85-310 RESIDENT'S RIGHTS: ( ! OAR 411-85-310 Resident's Rights; {
GENERALLY { i Generally. Please refer to page(s) 1 and 2 {
{ Refer to F tag 241. I I '
F tag 241. {
( i ! i
I i 15-4-98
i 1 I
I OAR 411-86-330 INFECTION CONTROL AND I { {
I UNIVERSAL PRECAUTIONS I ( OAR 411-86-330 Infection Control and
i Refer to F tag 444. i ! Universal Precautions. Please refer to
{ ( ! page(s)2 and 3,F tag 444. I
I i I i 5-4-98
I I ! I
I i I I
I ! ! 1
I i I i
f I i i
I i i
! 1 1 I
i I I
------------------------------------------------------------------------------------------------------------------------------------
FORM HCFA-2567L If continuation sheet Page 5 of 5
I ��i.
2
19"' ❑ Physician, physician assistant, or nurse practitioner orders for self-medication of
prescription medications
2 ❑ Medications reviewed every 90 days by RN, LPN, P.A., or physician
❑ TB tests done for residents within two weeks of move-in
The facility was not doing or ensuring that admission TB testing was done.
Administration of Services (411-56-010)
YES NO
Managed Risk/Shared Responsibilities
❑ Statement of problem, options offered, and approach used
❑ Statement of client choice and awareness of risk
❑"' ❑ Record of effort to mediate potential of consequences related to client choice
❑ Statement of outcome
Ancillary Services
❑� ❑ Pharmacy review
❑� ❑ Home Health
13'� ❑ Hospice
i� ❑ Other
Organization of Business (411-56-040)
Management Capability
❑' EJ Continuing Continuing education of administrator
Elc In-service and training of staff: Staff had received an in service on infection control and
vieWed a video on care for the Resident with Alzheimer dementia in the last year. There was no
plan to insure staff received training as they were needed.
Facility Standards (411-56-040)
IT ❑ Free from odor
Ef ❑ Free of rodent/insects
❑ Clean floors
❑ Covered soiled linens
Q" ❑ Perishable foods refrigerated
❑ Safe food storage and service
El ❑ Clean sinks, toilets, central bathing room, dining room furniture
❑ No Unstored/unattended equipment
❑ Kitchen/laundry H2O temperature 140 Degrees
Q ❑ Adequate lighting
d ❑ Covered garbage
❑
Safety:- water temperatures were 140 degrees F. in Rm230 and 138 degrees in Rm
. ^ , 1 . . ♦I- - t_ _. -I.. .....,.. _-L _t A AG _J____ _ _ P'1.....:.1.,w.4r.
s •3
K�
4 1
a F^c T
„3
had been warmed of the hot water but there were residents who were placed at risk
because of their physical or mental disabilities.
~Date SDSD to be Notified of Repairs/Corrections: 1
Monitor(s): Alice Wagner/ Kerry O'Brien
Facility Representative: re
'Discharge statistics: NH: Nursing Home, DE:Death,IND: Independent living arrangement,AFH:Adult Foster Home, RCF: Residential
Care Facility,ALF:Assisted Living Facility
SENIOR AND DISABLED SERVICES DIVISION FORM Ap
'i�
----------------------------------^---
__________________________________________________________ 'may,
--- ------------------------------------------------------------------------------------------------------
It
----------------------
INSTRUCTION
•� 'hs
S -----'—-- INSTRUCTION (X3)DATE SURVEY ? ,
F
COMPLETED
01/28/98
_. -------------------------------------------
N
-----------------------------------------------------------------------------------------------------------------------------------
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (XS)
PREFIX (EACH DEFICIENCY MUST BE PRECEEDED BY FULL PREFIX (EACq CORRECTIVE ACTION SHOULD BE CROSS- CCMPT_ETIC
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG REFERENCED TO THE APPROPRIATE DEFICIENCY) DATE
-----------------------------------------------------------------------------------------------------------------------------------
R1266 ( Continued From Page 1 )
tuberculosis testing.
Record review for three of four sample
residents reviewed for tuberculosis
testing revealed that Residents #s 1, 2
& 4 had not received tuberculosis
testing as required. This was confirmed
during interview with the care manager.
R1360 411-55-081(1) RULE: R1360
J FIRE & LIFE SAFETY:BUILDING FIRE. CODES
I (1) BUILDING AND FIRE CODES. Each
residential care facility shall meet
the requirements of the Oregon Building
Code and the Uniform Fire Code in
effect at the time of original
licensure and as required by Building
and Fire Code Agencies having
jurisdiction. When a change in use and
building code occupancy classification
occurs, licensure approval shall be
contingent on meeting the Oregon
Building Code in effect at the time of
such change.
This RULE is not met as evidenced by:
Based on observation it was determined
that the facility failed to
ensure that smoking and cigarette
management was carried out in a safe
manner. Observations of the outside
environment revealed three separate
piles of cigarette butts on the ground,
and cigarette butts in a plastic
laundry container. Interview with staff
indicated that the cicarette butts on
the ground and in the container were
from residents who smoked.
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STATE FORM If continuation sheet Pace 2 0: 6
AH
F- AND DISABLED SERVICES DIVISIONFORM APPRO
--------------------------------------------------------------------------------------------------------------------------
NF OF DEFICIENCIES I (XI) PROVIDER/SUPPLIER/CLIA ( (X2) MULTIPLE CONSTRUCTION } (X3)DATE SURVEY
} A. BUILDING ( COMPLETED
( B. WING } 01/28/98
-- ------------------------------------------------------------
NAP ZIP CODE
97030
------------------------------------------------------------
(X4) ID ( SUMMARY STATEMENT OF DEFICIE.YCIES } ID } PROVIDER'S PLAN OF CORRECTION f (X5)
PREFIX } (EACH DEFICIENCY MUST BE PRECEDED BY FULL } PREFIX } (EACH CORRECTIVE ACTION SHOULD BE CROSS- (COMPLETI,
TAG } REGULATORY OR LSC IDENTIFYING INFORMATION) ( TAG } REFERENCED TO THE APPROPRIATE DEFICIENCY) f DATE
-----------------------------------------------------------------------------------------------------------------------------------
R1360 } ( Continued From Page 2 ) ( j I
( Failure to provide appropriate } } }
} containers created a potential fire } } }
} hazard. } } }
R1.410 } 411-55-091(1) (A) RULE: } R1410 }
}
{ PHYSICAL ENVIRONMENT:GOOD REPAIR ( } }
( } I I
} PHYSICAL ENVIRONMENT GE3"RALLY (1)GOOD } } }
} REPAIR AND CLEANLINESS (a) All interior } } }
} and exterior materials and surfaces } ( }
} (e.g., floors, walls, roofs, ceilings, f } }
f windows, and furniture) and all ( } }
} equipment necessary for the health, I I }
( safety and comfort of the resident } }
( shall be kept clean and in good repair; } ( I
J This RULE is not met as evidenced by: } } I
} } } }
j Based on observation it was determined } }
} that the facility failed to maintain an f } }
j environment that was generally clean } f f
J
and in good repair.The facility overall } }
J presented an appearance of being
} unclean and in disrepair. Some of the } } }
f specific findings include: } }
} Four indoor chairs had tears on the J
} arms of the chairs and/ or slits } } }
f through the covering which crossed the } } }
} length of the seats of the chairs. An
} outside chair had a slit across the } } f
f seat which revealed the spring coils. f } }
f
An outside wooden bench was broken. One } ( {
} of the wooden cross boards from the J } f
f back was pulled away from one end and
{ hanging away from the bench. J ( }
I I I j
j Linoleum floors throughout the facility
f were discolored, and darkened black
{ throughout the contours of the } I f
j linoleum. There were areas of brawn and { I
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STATE FORM If continuation sheet Pace 3 of 6
iSENIOR AND DISABLED SERVICES DIVISION
-----------------------------------------------------------------------------------------------------------------------`-�'.
ST;_ - ----- �-� ..e....rT�rD/CTTDDT.TF:T!IfT.iA I (X21 MIILTIPLE CONSTRUCTION
I (X3)DATE SURthy
A WILDING
I COMPLETED
.NG I 01/28/98
---------------
------------------------------------------------- ----------------------------------------------------
(X4) ID I SUMMARY STATEMENT OF DEFICIENCIES I ID I PROVIDER'S PLAN OF CORRECTION I (Xs)
PREFIX I (EACH DEFICIENCY MUST BE PRE ED BY FULL I PREFIX I (EACH CORRECTIVE ACTION SHOULD BE CROSS- ICCMPLETZO)
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) I TAG I REFERENCED TO THE APPROPRIATE DEFICIENCY) I DATE
------------------------------------------------------------------------------------------------------------------------------------
R1410 I ( Continued From Page 3 ) I I I
I grey discoloration on top of the I I I
I darkened linoleum. There were splits in
I the linoleum including in the lobby
I area, which presented with a dark black
i coloring. The linoleum gapped at the I I I
I baseboard in one of the bathrooms so I I
I that the surface was not cleanable. The I I I
I linoleum in the upstairs men's bathroom I I I
I was dark and discolored around the base I I
I of the toilets.
I I I I
The privacy curtain in the women's I I
I bathroom was soiled with a brown matter
I on the edge of the curtain. There was a I I I
privacy curtain missing from one of the I
I two toilets in the same bathroom.
I I I I
There was a build-up of dust along the I I I
I too of the baseboard heater in the I I I
I upstairs TV room, and along the hall I I I
I cross boarding.
I I I I
Debris was felt by running one's hands I I I
I over the top of the dining room tables. I I I
There was a pile of debris in the I I I
I corner of the downstairs dining room.
I I I I
Shelves in the kitchen were discolored I I I
i with black and grey markings and I I I
I contained loose debris. I I I
I I I I
The walk-in refrigerator had a cracked I I I
I and broken interior wall. There was I I
brown discoloration on many areas of I I I
the interior wall, and at one corner I I I
I there were two black streaks from the I I
ceiling down the wall. I I I
I I I I
There was a build-up of dust on the ( I I
paper towel holder in the kitchen. I I I
I I I I
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S:'ATE FCRM If continuation sheet Pace 4 of 6
FORM APPRO
---------- t •.... ....•..........etnnt
, tro in t. -I (X2) MULTIPLE CONSTRUCTION I (X3)DATE SURVEY
A A. BUILDING I COMPLETED
S. WING i 01/28/98-Revisit
----------------------------------------------------------
'P CODE
OR 97845
------------------------------------------------------ ---------------------------------------------------------
(X4) ID I SUMMARY STATEMENT OF DEFICIENCIES I ID 1 PROVIDER'S PLAN OF CORRECTION 1 (X5)
PREFIX I (EACH DEFICIENCY MUST BE PRECEEDED BY FULL I PREFIX I (EACH CORRECTIVE ACTION SHOULD BE CROSS- ICOMPLETI
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) I TAG I REFERENCED TO THE APPROPRIATE DEFICIENCY) I DATE
R 000 1 MEMO TAG: I R 000 I I
I INITIAL COMMENTS I I I
I I I I
I I I I
I I I 1
I I I I
I This report reflects the findings of a I I I
I follow-up visit to the facility on I I I
1 1/28/98. A review of the facility's I I I
I submitted plan of correction specific I I I
I to the 8/21/97 survey was done and I I I
I technical assistance was provided.
During the 1/28/98 visit, it was noted I I I
I the facility's wiring system did not
meet the Residential Care Facilities I I
I regulations. Specifics are as follows: I
I I I I
R1550 1411-55-141(1)(A) RULE: I R1550
I ELECTRICAL:WIRING SYSTEMS I I I
I I I I
I (1)(a) ALL wiring systems shall meet ( I I
I the Oregon Electrical Specialty Code in
I effect at the date of installation and I I I
i devices shall be properly wired and in I I I
I good repair. When not fully grounded, I I I
I circuits in resident areas may be
I protected by GFCI type receptacles or I I I
I circuit breakers as an acceptable I I I
I alternative;
I I I I
This RULE is not met as evidenced by: I I I
I I I I
I During the 1/28/98 revisit, it was I I I
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LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE I TITLE I(X6) DAT
I I
I I
----------------------------------------------------------------------------------------------------------------------------------
If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
----------------------------------------------------------------------------------------------------------------------------------
STATE FORM If continuation sheet Page 1 of 4
a
--------------------------------------------------------------------------------------------------------------
rT.TrucuT nF nFFTCTENCfES ( (X1) PROVIDER/SUPPLIER/CLIA } (X2) MULTIPLE CONSTRUCTION 1-03
KATION NUMBER: f A. BUILDING
1011 f B. WING f a
--------------------------------------------------------------------
4 -cT ADDRESS, CITY, STATE, ZIP CODE
13 S CANYON BLVD JOHN DAY, OR 47845
-- -•-------------------------- ---------------------------------------------
(X4) ID f SUMMARY STATEMENT OF DEFICIENCIES f ID } PROVIDER'S PLAN OF CORRECTION
PREFIX } (EACH DEFICIENCY MUST BE PRECEEDED BY FULL f PREFIX f (EACH CORRECTIVE ACTION SHOULD BE CROSS-
TAG f REGULATORY OR LSC IDENTIFYING INFORMATION) f TAG f REFERENCED TO THE APPROPRIATE DEFICIENCY)
81550 f ( Continued From Page 1
f noted the facility's outlets were not f f f
f fully grounded in resident areas. OAR
} 411-55-141 (1) (a) was reviewed with
} the Administrator. The installation of I } }
f GFCI type receptacles or circuit
f breakers as a method to provide the ( I I
f required protection was discussed with } f f
} the Administrator. I f }
I I I 1
I I 1 I
I I ! 1
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I ! I !
E ! I
! ! I I
I I ( I
i I I I
I I i i
I I 1 I
I I I I
I ! I !
I I ! !
! ! I I
I i I
I I I I
f { f S
i I I I
I ! I !
I I I I
S l i I
I 1 I I
f I I
f } I f
f f I I
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STATE FORM if continuation sheet Page 2 of 4
SENIOR AND DISABLED SERVICES DIVISION
FORM APPRO
-------------------------------•----------------------_--------------------------------------------------------------------------
STATEIENT OF DEFICIENCIES I (X1) PROVIDER/SUPPLIER/CLIA I (X2) MULTIPLE CONSTRUCTION I (X3)DATE SURVEY
ANS I COMPLETED
J 04/03/98
'-- ---------------------------------------------
NAM.
H
---
(X4) ID J SUMMARY STATEMENT OF DEFICIENCIES J ID f PROVIDER'S PLAN OF CORRECTION I (XS)
PREFIX J (EACH DEFICIENCY MUST BE PRECE=DED BY FULL I PREFIX I (EACH CORRECTIVE ACTION SHOULD BE CROSS- (COMPLETI
TAG J REGULATORY OR LSC IDENTIFYING INFORMATION) J TAG I REFERENCED TO THE APPROPRIATE DEFICIENCY) J DATE
--------------------------------------------------------------------------------------------------------- ----------------------
R1489 J ( Continued From Page 5 ) I I I
J compartment sink and would be the same I J I
( temperature. J I
I I J (
R1510 1411-55-121(1) RULE: J R1510 ! I
J DETAILS/FINISHES:HANDRAILS J
J I I J
( (1) HANDRAILS, Handrails shall be ( J
J installed at one or both sides of I J
J resident use corridors in all J J I
( residential care facilities licensed on J J I
J or after January 1, 1994, and in all ( I I
{ facilities constructed prior to this { I I
date when residents are admitted and I I J
J retained needing their use. J J J
I I I {
J This RULE is not met as evidenced by: ( J
I ( ( I
( Based on observation it was determined J J I
that the facility failed to install J ( J
( handrails in the resident use corridor J I I
I on the west end of the second floor. I J I
R1533 ( 411-55-131(4) (A) RULE: J R1533 ( J
( IMATING/VENTILATING:EOT WATER TE,MP_RATU J I I
I I I I
( (4) (a) In resident areas, hat water J J J
temperature shall be maintained within J ( I
J a range of 110 to 120 degrees
I Fahrenheit; and I J I
I This RULE is not met as evidenced by: I J
1 f I
I Based on observation it was determined ( I
J that the facility failed to maintain J J
I hot water temperatures at resident J J {
J handwashing sinks, shower and tub. ( I I
I Findings include:
{ I I (
J 1. The resident handwashing sinks on
J the first floor bathrooms had hot water ( I
J temperatures of 80 and 84 degrees F. { J
------------------------------------------------------------------------------------------------------------------------------------
STATa FORM If continuation sheet Page 6 of 9
RECEtvI~ >r�
AR
DEPART:I.E_`3T OF HEEALTri AND HUMAN SER`IIC=S APR 2 8 1998
FORM A??RG V'.
IjM'AL--! CAR' --=IMNC:NG ADMINISTRATION
ZSo%-:
--------------------------------------------------------------------'�A#� {s{�1_C1GnLiC1------
f
S?A?ZNEVT OF DEFIC:--ICIES ( tx:) PROVIDER/STQPPLIZ.R/C-:A ro .ar,.r-�T.r. CONS' LL�?€C1 OCIATIU( ) JA _
S 'J Y
AN, ( CCM;L _=D
033/09/98
----
NAME
C.at
------
(x4) I- ( SUM-MARY STATEMENT OF DEri.CI=.VC :S ( ID I PROVIDER'S PLAN OF CORREC'-ICN --- (X_;
PREFIx I (EACH DE-ICIEV(:-! M4S: BE PREC==-''E7 BY rat ( PREF:x ! (EAC:t CORRECTIVE AC--ICN S,,jo D BE CROSS- ICOM?L77:G
TAG ( REGULATORY OR LSC IDEY".%FYZNG INFCRMA^ON) ( TAG ( R'FERrr"tCET.) TO T:-IE APPROPRIATE DE'IC:ZNCy) j ZATS
-----------------------------------------------------------------------------------------------------------------------------------
coo ( MEMO TAG: ( F 000 I
( INI T IAL OMME`ITS
I I I
( MAR 3 1998
s
I This is the report of the annual I I
SE(
�LENTCAREbK?tl8�� PAGUt4t
certification sorrel r.el cpmplet d oI (
r
?UAUM
( 3/9/98. I I l
323 j 483.25(h)
_S=v ( QUALITY OF C-;R= ( 1
i
I I {{ 1
The faci_ity most ensure that the {
(
resident a^v==creme^t reatai s as :r__ ;
j c-- accident hazards as is possiwle. ( ,
E
I 1 i I
( This REQt1IRZME21 is not met as evidenced by) ( I
I I I I
( Based on obser✓ation and interview, itI
j was determined that the facility failed I I
( to ensure chat the envir:nme1 remained
( as t_.._ of accident hazards as I I I
possible. Findings include: i I The drain cover was replaced, all
3-9-98
I
( ! ocher drain covers wer-inspected
T_. On 3/6/98 the drain in the shove. I I and repaired as needed. All drain
stall an the C-Hall did not have a I « covers are on a preventive
cover. There was an approximate four ( I maintenance schedule and will be
( inti; hole in the shower floor where the I I monitored by the Environmental I
( drain cover was missing. Interview with I I Supervisor,and Administrator. I
( a staff member indicated tae dr31n I I
( cover had been missing for awhile. The I I
------------------------------------------------------------------------------------------------------------------------------------
LA3CRATORY DIRE:_L.R' OR PRCV:DER/SuPPL:ER R—rPRES'cNYTA::VE'S SIMNATGnE ( T: r�F I (X6:
A4,/
-------- --- --------------------------------------------------------A107��40-----------------------------
Any deficiency statement endiaa with an asterisk (') 3e:otos a defic__.tf which may be excused .ram carrectior. pr=vid- � -- is
determined that other safecuazds provide sufficient protection zo c::e patients. ,he findings stated above are dNsc'eseabi'- Wien-mer
or ncc a pian of correction is provided_ :he findings are d;sc'_eseaaie within :4 days after such inft ration is made avai_a..__
tae facility. If deficiencies are cited, an approved pian of ccrrect:cn is requisite to continued program pan ic-_-t-.....
------------------------------------------------------------------------------------------------------------------------------------
-vRM a�:?-2507?, If conti-ua--cr. she-zc ?age 1 ,.f 4
{ D£PARTMEYI OF HEALTH AND HUMUM S'cRVIC=S
FO"-'AP
HE. .A CAR± FINANCING ADMINISTRATION
2_=��256
f v- + �
S A -- OF DEFICIENCIES (X11) PRGViDER/SUPPLISR/CTIA MTT7,-PLZ CCNSTRUC7ON tX3}DAiS^R V. .
P i CCMPLE--
I 02/09/98
-xr.
--- ------------------------------------------
YAa`y
C.?
---- ------- -----------------------------------------
(X3) ID I SUI-IARY STATsEIT OF DE?ICIr-`7CI=S J ID i PROVIDER'S ?LAN OF CCR2rC:ICN i iXz;
PREFIX I (EACH DEFICIENCY MUST BE PREC=- ED BY FULL J PREFIX ! (EA(=i CORREC:VE AC--ICN SHOULD BE CROSS- I COMP=.:(
TAG 1 REGULATORY OR LSC IDENTZFY--W INFORMATION} ( TAG 1 REFERM"CED TO THE APPROPRIATE DEFICIENCY) i DA^
-------------------------------------------------------------------------------------------------------.,._---------------------
F 323 I ( Conc'_nued From Page I
I missing drain cove_ presented an I I !
I accident hazard for residents and I I 1
I staff.
i 2. On 3/6/98 the central supply door i
I was not locked. There were oi:cments 1 ! A permanent locking doorknob was
and medical supplies in the room. i { installed by the maintenance i
! Inside the central supply room was ( I supervisor. This will be monitored
i another enclosed lockable area which I I by Environmental Supervisor, i
I was unlocked. That area also contained ! ! DNS,and Administrator. i
I medications and medical sacplies.
! :do staff members cave conflicting ( ( !
I information _ _ardi:.c whether or not ! i
the doors to central supply and the i !
I additional enclosed area were to be
{ locked.
3. On 3/6/98, theEnhanced Care unit
I nursing station door was observed to be ! I I
Pe:State Fire Marshall an
I propped open. The ursine station ! I automatic door closer and magmetic '
j Contained resident __cords cr. an toe.^. i I holder is installed on the enhanced I
! she!f. scissors, stet`oscones, i ! unit staff room door. This door
I medicat_on/treatment cart and a variety I i will remain locked when staff is not {
I of miscellaneous items. Two residents I ! present. Staff will be regularly
j
were pbser�ed to enter tte r--cm vi:�cut ! 4 }nservic:d accordina to policy-
staff supertision. The door :.ad a sign i I Compliance will be monitored by 1
i
(
which read "Keep Door ;,poked.• An I Charge Nurses,DNS,and
I inceznr ew with the :vC-M (R-*t Care ( { Administrator.
I Manacer) revealed -.--at the nursing ( I !
! station door should be closed and I I
! locked when the room was not oc=.pied
I I i I
{ I !
i i (
i I I I
I ! I
-----------------------------------------------------------------------------------------------------------------------------------
Fc;;Z:l HCFA-25o7L I` cont_rua-tor. snee^ Pace 2 of 4
r'�;-'— -
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPR
HEALTH CARE FINANCING ADMINISTRATION 2567-L
$�._..,.. ..r-..r -- t-..... nn.....ncn.cv neica.ri• - -..•_-----� /Y9\-Mill T101 muc-ronN
PTin ---------i (X3)OATE SURVEY ------
COMPLETED 7
t ,
02/06/98
------------------------
Nl
------------------------------------------------------------ -- -------------------------------------------
(X4) ID l SUMMARY STATEMENT OF DEFICIENCIES l ID l PROVIDER'S PLAN OF CORRECTION } (X5)
PREFIX } (EACH DEFICIENCY MUST BE PRECEDED BY FULL l PREFIX (EACH CORRECTIVE ACTION SHOULD BE CROSS- {COMPLETION
TAG ( REGULATORY OR LSC IDENTIFYING INFORMATION) { TAG ( REFERENCED TO THE APPROPRIATE DEFICIENCY) } DATE
-----------------------•------------------------------------------------------------------------------------------------------------
F 331 ( ( Continued From Page 9
l forms revealed the 11/29/97 and
} 11/30/97 incidents of aggressive { ( I
} behavior had not been documented. There l { {
} were no interventions or responses to
} those interventions listed on the { {
i monitoring form. An interview with the } l {
} direct care staff on 2/4/98 revealed ( {
i that Resident #5 usually responded best { { I
{ when the staff discussed his ( I
} background, such as his family farm and { { I
} his wife. The staff also stated that { }
{ the resident became weepy at times and { { {
} the best approach was to talk with him } { }
} about the circumstances. Those { { l
} interventions were not listed on the } { }
{ resident's care plans or Behavior { { {
} Monitoring form. { ( {
} There was no assessment of the { { I
i circumstances around the periods of { { I
{ aggressive behavior. There were notes { I
l in the record referring to the resident
possibly having pain, but there was no } } {
assessment his behavior might be due to
} pain. There was no assessment that the { } }
l behavior was evident only during the { { I
} evening shift. The staff approaches to
} the resident were not reassessed and { { }
{ modified prior to the increase of the
} antipsychotic medication. { { {
I { ( }
F 465 ( 483.70(h) REQUIREMENT: ( F 465 {Faulty regulator valve replaced. 12/5/98
SS=B } PHYSICAL ENVIRONMENT { lEnviramientiil sup(=rwisor will RY:lnitor/chegk
I l {for tEnpesature caTipliance.
{ The facility must provide a safe,
functional, sanitary, and comfortable
} environment for residents, staff and
t {.��� 7`rr�� h1 GT 4'C'� /'t?Z-//7'/�•"".• r'9 I
the public. { {/✓ �/u �C.�l�" 3�3�5'S' /�-3/��t{''''
I I {
-----------------------------------------------------------------------------------------------------------------------
FORM MCFA-2567L If continuation shcet Page 10 of 14
AH
x.'OF HEALTH AND HUMAN SERVICES FORM APPROVED
CARE FINANCING ADMINISTRATION 2567-L
--------- -----------------------------------------------------------
'/Cita ' (RUCTION ( (X3)DATE SURVEY
} COMPLETED
! 02/06/98
----------------------------------------
R
•---------------------------------------------- ---------------------------------------------------------------------
CX4) ID ! SUMMARY STATEMENT OF DEFICIENCIES } ID } PROVIDER'S PLAN OF CORRECTION I (XS)
PREFIX } (EACH DEFICIENCY MUST BE PRECEEDED BY FULL } PREFIX } (EACH CORRECTIVE ACTION SHOULD BE CROSS- }COMPLETION
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) } TAG } REFERENCED TO THE APPROPRIATE DEFICIENCY) I DATE
-----------------------------------------------------------------------------------------------------------------------------------
465 } ( Continued From Page 10 ) I I I
I This REQUIREMENT is not met as evidenced by} I I
I Based on temperature readings, a } ( }
} resident statement and staff } } I
} conversations, it was determined the } } }
facility failed to consistently } I }
} maintain water temperatures in bathing } } I
I areas on the North wings of the } } }
facility to within comfortable - } } }
} parameters. Findings include: } ( I
1. dater temperatures taken by a I } }
} surveyor between 7:00 and 7:15 a.m. and I ( I
} at 11:50 a.m. on 2/3/98, and at 8:06 } } }
} a.m. on 2/4/98, revealed hot water ( I }
} temperatures from 88 to 92 degrees }
} Fahrenheit in the North fling shower, } } }
} whirtpoot tub and Century tub. I }
I During the group interview on 2/4/98, } } I
an alert and oriented resident stated } } }
! she had her bath delayed as the water } ( }
I had been too coot on 2/3/98. } }
I A staff member stated the hot water }
I temperatures in the bathing rooms on } }
I the North wing were coot "once in a ( } }
} while." } } }
! ! } I
} I ! }
! 1 I f
} I I I
I ! } I
I I ! }
i l I i
----------------------------------------------------------------------------------------------------------------------------------
iRM HCFA-2567L If continuation sheet Page 11 of 14
i0f:HEALTH AND HUMAN SERVICES FORM APPR•
DIRE FINANCING ADMINISTRATION 256'
--------------------------------------------------------------------------------------------------------------------------
.,c nccTrncurTFc 1 (X11 PROVIDER/SUPPLIER/CLIA ( (X2) MULTIPLE CONSTRUCTION ( (X3)DATE SURVEY
( COMPLETED
( 01/23/98
---------------------------------------
---------------------------------- •-------------------------------------
(X4) IO ( SUMMARY STATEMENT OF DEFICIENCIES I IO { PROVIDER'S PLAN OF CORRECTION I (X5)
PREFIX { (EACH DEFICIENCY MUST BE PRECEDED BY FULL j PREFIX j (EACH CORRECTIVE ACTION SHOULD BE CROSS- jCOMPLE'
TAG I REGULATORY OR LSC IDENTIFYING INFORMATION) j TAG j REFERENCED TO THE APPROPRIATE DEFICIENCY) I DATI
---------------------------------------------------------------------------------------------------------------------------------
F 369 j ( Continued From Page 6 ) j I I
j she had difficulty seeing the food ( { {
( items as she used her spoon to find the I ( I
j food items.
{ At the breakfast meat served on
( 1/23/98, again the resident did not
I have a plate guard. ( {
{ 2. Resident #9 was admitted to the
{ facility on 5/25/97 with diagnoses
j which included insulin dependent
( diabetes mellitus, congestive heart
( failure, and an enlarged heart with j {
j angina.
I I I I
( Review of the resident's tray card and ( {
( dietary cardex on 1/23/98 revealed the { I
{ resident was to have a plate guard.
{ I I I
( Observations of the breakfast meal ( ( I
j served to Resident #9 on 1/23/98
( revealed there was no plate guard ( ( I
{ provided. ( { I
i I i I
F 371 ( 483.35(h)(2) REQUIREMENT. { F 371 { I
SS=C j DIETARY SERVICES
( The facility must store, prepare, i The facility stores, prepares, distributes and serves 03/23
{ distribute, and serve food under 1 food under sanitary conditions. The laminant I
{ sanitary conditions. { I
j j counter surface will be replaced on the counter in {
j This REQUIREMENT is not met as evidenced by( the dry storage area, the kitchen counter tops and the j
{ { tray line counter. I
I ( The RD will submit a monthly and PRN sanitation 4
j Based on surveyor observations during
j the tour of the kitchen and staff j . assessment to the Administrator which will include {
j interview, it was determined the ( monitoring of work surfaces and storage area I
( facility had not ensured the laminate ( shelving. j
{ counter surfaces were maintained to ( j
( prevent the development of exposure of
{ porous subsurface material which ( ( Continued on Page 8 I
---------------------------------------------------------------------------------------------------------------------------
FORM HCFA-2567L If continuation sheet Page 7 of
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPR
HEALTH CARE FINANCING ADMINISTRATION 2567-L
--.----------------------------------------------------------------------------------------------------------------------------------
- nc nFFiCIENCiES I (X1) PROVIDERISUPPLIERICLIA i tY71 MUI TIPLE CONSTRUCTION ( (X3)OATE SURVEY
ING ( COMPLETED
{ 01/23/98
---------------------------------------------------
------- - ---------------------------------------------------
(X4) ID ( SUMMARY STATEMENT OF DEFICIENCIES ( iD ( PROVIDER'S PLAN OF CORRECTION ( (XS)
PREFIX { (EACH DEFICIENCY MUST BE PRECEEDED BY FULL { PREFIX ( (EACH CORRECTIVE ACTION SHOULD BE CROSS- (COMPLETION
TAG ( REGULATORY OR ESC IDENTIFYING INFORMATION) { TAG ( REFERENCED TO THE APPROPRIATE DEFICIENCY) ( DATE
------------------------------------•------------------------_-------------.-----•--------------------------------------------------
F 371 ( ( Continued From Page 7 ) { The cooks will continue to use the provided cutting
{ rendered the surface uncleanabte. I
( Findings include- ( boards and trivets will be purchased to reduce wear
{ ( and tear of the surface by hot pans during tray line I
( 1. During a tour of the kitchen on ( service. {
( 1/20/98 at 10:45 a.m., the surveyor (
( observed multiple circular areas of { All audits will be compiled into a quarterly Quality j
{ worn laminate on an island countertop { Assessment and Assurance report by the FSS and I
{ in the dry storage room. The worn areas ( submitted to the Administrator for monitoring.
{ exposed the porous material under the
( laminate surface. A can opener was ( —Monitored by Administrator
( attached to the island counter. Staff ( {
( stated cans of food were opened
{ periodically at the island countertop { ( {
( work area.
{ { { {
( 2. Observations made at the same time
{ in the primary kitchen area revealed { {
( worn laminate to the left of the ( ( {
{ handwashing sink. The area was {
( approximately 2Z inches by 8 inches at { { {
( the widest points.
( ( ( {
( 3. The strip of laminate at the edge
{ of the tray line counter was observed {
( to be wearing down, exposing dark under
areas where the laminate had been worn ( {
( off. ( 1
( 4. During an interview with the
( maintenance supervisor on 1/22/98, it ( ( 1
{ was learned the facility had been aware ( ( {
( of the worn Laminate surfaces in the
( kitchen, however, no pians had been ( { {
( established to repair them.
I ( The facility will continue to require staff to wash 103/23/98
F 444 1 483.65(b)(3) REQUIREMENT: ( their hands after each direct resident contact for I
SS=E ( INFECTION CONTROL ( which hand washing is indicated by accepted I
I ( professional practice. All staff, including Agency 1
( The facility must require staff to I personnel, Will be Inservlced to proper hand Washing 1
( wash their hands after each direct I 1
( resident contact for which handwashing 1 technique. Continued on Page 9
------------------------------------------------------------------------------------------------------------------------------------
FORM HCFA-2567L if continuation sheet Page 8 of 12
�RF(' FIVFD
DEPARTMENT OF HEALTH AND HUMAN SERVICES APR 2 81998
Al
HEALTH CARE FINANCING ADMINISTRATION "A" FORM
---CIENCIES WHICH m^ VIDER # DATE SURVEY
'AL FOR MINIMAj�A COMPLETE:
385182 01/23/98
STREET ADDRESS, CITY, ST, ZIP
525 S 2ND STREET
CRESWELL, OR 97426
ID
PREFIX SUMMARY STATEMENT OF DEFICIENCIES
TAG
F 256 483 . 15 (h) (5) REQUIREMENT:
ENVIRONMENT
The facility must provide adequate and comfortable lighting levels
in all areas.
This REQUIREMENT is not met as evidenced by:
On two separate days of the survey, Resident #15 was sitting in a
wheelchair next to her bed doing cross-stitch needle work. The
overbed light pull cord was not within the resident's reach. Several
staff were observed to walk by the resident as they entered her room
without offering to turn the light on. Turning the light on for the
resident resulted -in the resident saying, "Oh, thank you" and
turning towards to light source to continue her needlework.
The above isolated deficiencies pose no actual harm to the residents. s
If continuation sheet Page 1 of 1
TMENT.OF HEALTH AND HUMAN SERVICS FORM AP-,ROVE.-
TH CARE FINANCING ADMINISTRATION 2567-L
-----------------------------------------------------------------------------------------------------------------------------------
STATEH NT OF DEFTCTF.NCT:c i Ivi t nonvTnrn/crrnnr rra/++* 1 /v-+- -)NSTRUCTION J (X3)DATE SURVEY
J COMPLEiaD
( 01/23/98
-- -------------------------------------------
NP
--------------------------- ------------------------------------------------------------
(X4) ID J SUMMARY STATEMENT OF DEFICIENCIES I ID J PROVIDER'S PLAY OF CORRECTION I (X_=)
PREFIX ( (EACH DEFICIENCY MUST BE PRE ED BY FULL ( PREFIX ( (EACH CORRECTIVE ACTION SHOULD BE CROSS- JCOMPLn ION
TAG ( REGULATORY OR LSC IDENTIFYING INFORMATION) I TAG 1 REFERENCED TO THE APPROPRIATE DEFICIENCY) I LATE
-------------^-----------------------------------------------------------------------------------------------------------------------
F 332 1 ( Continued From Page 19 ) I I
I
f The physician's order dated 12/19/97 { J J
( read "Lactose 30cc po BID." f 1
J In an interview with the C:wA (Certified ( J J
f Medication Aide) and the RNCM on f J I
f 1/21/98 at 9:15 a.m. it was confirmed f f J
1 that the resident had probably received ! I J
i only 20 cc twice a day since 12/19/97, ( I I
( and that the original physician's ( ( I
J orders, which were received via J J I
J telephone facsimile, looked like the J J
1 dosage could have been 20 or 30 cc BID. ( J I
I The RNCM confirmed that no follow-up 1 J
J telephone call was made to the J I
J physician to clarify the right amount ( J J
I of Lactose. J J J
I I I J
( 2. During the medication pass on ( ( I
( 1/21/98 between 3:15 and 3:50 p.m., the ( I
J cAA gave a resident five different J J !
J medications. The MAR indicated that J J
I Colace 100 mg po BID was to be given at
( 4:00 p.m. also. The CMA did not pour J i
( the Colace, finished passing the five ( ( J
( medications to the resident and J J I
J proceeded to start pouring meds for the
J next resident. I ( J
I J J J
i During an interview at 3:55 p.m, the ( ( J
I same day, the CMA confirmed that she J J I
( had forgotten to give the Colace and I I J
1 the resident would not have received J 1
J the medication twice that day if it had ( J J
J not been brought to her attention. J I
I J i I
465 J 483.70(h) REQUIREMENT: J F 465 ( {
SS-E J PHYSICAL ENVIRONMENT I J I
J The facility must provide a safe, ( I
( functional, sanitary, and comfortable J J
( environment for residents, staff and I I J
-----------------------------------------------------------------------------------------------------------------------------------
'ORM HCFA-2567L If continuation sheet Page 20 of 25
D£PAP MENT OF HEALTH AND HUMAN SERVICES FOF
HEALTH CARE FINANCING ADMINISTRATION
-----------------------------------•---`----------------------------------------------------------------------------------
cTaT-+.r�r. nr nrrTrTru TrC 1 1Y11 VQOVTDF..R/SUPPLIER/^ " (Y11 MITT.TTPLE CONSTRUCTION { (X3)DATE SURV
{ COMPLETED
( 01/23/98
---------------------------------
--------------------------------------- -- --------------- •----------------------------------
(X4) ID { SUMMARY STATEMENT OF DEFICIENCIES ( ID { PROVIDER'S PLAN OF CORRECTION (
PREFIX J (EACH DEFICIENCY MUST HE PRECEEDED BY FULL ( PREFIX J (EACH CORRECTIVE ACTION SHOULD BE CROSS- (C
TAG ( REGULATORY OR LSC IDENTIFYING INFORMATION) J TAG ( REFERENCED TO THE APPROPRIATE DEFICIENCY) J
------------------•-------------------------------------------------•------------------------------------------------------
F 465 ( ( Continued From Page 20 ) { x465 Hous 1 J
�.kcapir.4 5'upe_wi.sor will i-eple.:.e=it
J the public. J corrective actions for residents affected by
J ( tYas practice, including: A ccawlete cieenirg J
of the Areas ideat--tied iz the sic.--vey have
( This REQUIREMENT is not met as evidenced byj been ad;.ressed. The s-)aoer rooa areas have J
J ( been corrected. The facility has instituted J
J Based on observations from 1/20 through { sounds in order to i tify areas in need of J
attention, :r is has been in serviced tort% put
J 1/22/98 it was determined that the ( into place. The facility Administrator will J
J facility failed to provide a sanitary ( receive. these round audits and develop plans
necessary to correct any areas identified. Mne
{ environment for the residents. ( department heads are responsi.bie for the {
J Findings include: J timely ccple:ion of these rounds audits. The J
J �Admi.ristra:or is responsible for review and
J timely correction. The faci__ty sea: hav-
{ 1. During the general observations ( been in service on the proper cleaning {
j tour of the facility it was noted that j proced-ures for =lti-use ite.L. and areas. {
Return demonstrations h..ve been or,rervvd. The
( resident room #1 had loose dirt and J DS] uri11 er-sure that -.tee s:a£: are properly J
educated or- the process during =I-.e orientation
J dust balls on the floor under the bed, j j
iti-ine period. The facility Administrator enc
( the baseboard heater and behind the ( ;D-NS w--'-1 e srs cc= iaice. J3
J hallway door. There were reddish brown ( {
( marks on the floor tile under the head ( i(
j and foot of the beds in the room. The
J sheet rock walls had deep gouges and
{ scrapes approximately four to six feet { J
j up from the floor and made the surfaces
J uncleanable. J
( Resident room #6 had reddish brown ( ( {
( marks on the beige floor tile under the
{ head and foot of the beds in the room. ( { J
( There was loose dirt behind the hallway
{ door. ! { {
( 2. The common shower room used by ( J {
( residents in the west wing between room
( #'s 10 and 11 had floor tile missing in { {
( the shower drain area. wall tile J {
( chipped with pieces missing, and the
( junction where the handrail was { I
J attached to the shower divider wall had
J cracked and broken tiles, all of which ( J
J presented uncleanable surfaces. The { J {
J ceiling exhaust fan was clotted with J
j dust, dirt and cobwebs. J ( J
J ( J
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FORM HCFA-2S67L If continuation sheet Pace
ARTME*IT�OF HEALTH AND HUMAN SERVICES FORM APPR
TH CARE FINANCING ADMINISTRATION 256
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STaTLM=-YL OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION y
1 } ( W)DATE SLZr VE_
AND PLAN OF CORRECTION ( IDE`7TZFZCATION NUMBER: } A. BUILDING
} CCMPLETED
} 385212 ( B. WING } 01/23/48
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NAME OF PROVIDER OR SUPPLIER J STREET ADDRESS, CITY, STATE, ZIP CODE
EVERGREEN HEALTH AND SPECIALTY } 3011 NE 28TH STREET LINCOLN CITY 97367
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(X4) ID ( SUMMARY STATEMENT OF DEFICIENCIES } ID ( PROVIDER'S PLAN OF CORRECTION I (XS)
PREFIX } (EACH DEFICIENCY MUST BE PRECEEDED BY FULL I PREFIX I (EACH CORRECTIVE ACTION SHOULD BE CROSS- ICOMPLE
TAG ( REGULATORY OR LSC IDEPITIFYING INFORMATION) I TAG J REFERENCED TO THF APPROPRIATE-, DEFICIENCY) i DAT
—------------------------------------------------------------------------------------------------------------------------------
F 465 } ( Continued From Page 21 ) I I I
} 3. The common shower room used by } } }
I residents in the east wing between room } } }
} #'s 32 and 33, had loose/wet brown } } }
} matter on the floor of the shower } } }
f drainage area. Semi-dissolved wet } ( }
} paper towels were strewn about the f } I
} floor along with a wet used washcloth. } } J
} The shower chair used by residents was } }
} noted to have partially dissolved } } 1
} toilet paper draped on the seat and ( ( J
} armrest area. ( } }
I I I }
j 4. The tub room used by residents in } } }
} the north wing near room #2 had vinyl
} floor covering that had } }
( separated/lifted up at the seam and } J J
} presented a tripping hazard and } ( }
} uncleanable surface. There was loose } }
} dirt, and dried flower blossoms on the } ( }
I floor in the northwest corner of the } } }
} room. The shower chair stored in the } }
} room and used to shower residents had } } }
} dried caked brown matter on the seat } } }
} and rails next to the seat. I } }
I } I }
} 1 1 }
I I ! I
I I } !
I I I }
1 I I i
f } } 1
I I I }
I 1 I i
f 1 I }
! } I I
} I 1 }
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FORM HCFA-2567L If continuation sheet Page 22 of
ACPO
Adult Care Providers of Oregon
Washington County Chapter
15405 SW 116th Ave., Suite 103-A,King City,OR 97224
Office: 503 684-1800 Fax: 503 684-5828
August 6, 1998
Community Housing Task Force
City of Tigard
RE: Social Care Facilities - Adult Foster Care Homes
Good afternoon. My name is June Sulffridge. I am the President of the Washington County Chapter of
ACPO; State Treasurer for ACPO; State Board Member; Committee member for the Subcommittee on
Medicaid Reimbursement for SDSD in Salem; and my husband and I own an adult foster care home in
Washington County. I have been asked to represent Washington County adult foster home providers at
today's meeting of the Community Housing Task Force regarding the issue of Social Care Facilities.
Let me begin by giving you a couple of definitions.
Definition of Adult Foster Care in Oregon
Per Administrative Rules for Licensure of Adult Foster Home", dated 4/1/96, Section
411-50-400(3)(Definitions) " "Adult Foster Home (AFH)" means any family home or other facility in
which residential care is provided in a home-like environment for compensation to five or fewer elderly or
physically disabled adults who are not related to the provider by blood or marriage. For the purpose of
this rule, adult foster home does not include any house, institution, hotel or other similar living situation
that supplies room and board only, or room only, or board only, if no resident thereof requires any
element of care."
Page I
Community Housing Task Force
City of Tigard
August 6, 1998
Per City of Tigard Municipal code 14.16.070(h)(Definitions) "Social Care Facilities. Any building or
portion of a building containing three or more dwelling units, which is designed, built, rented, leased, let,
hired out or otherwise occupied for group residential living purposes, which is not an apartment house.
such facilities include but are not limited to, adult foster care, retirement homes, half-way houses, youth
shelters, homeless shelters and other group living residential facilities."
By the definitions quoted above, adult foster care homes do not qualify as Social Care Facilities since
they are single family homes, providing a "home-like" environment for five or fewer elderly persons.
They do not consist of"three or more dwelling units", they are a "Single-Family Dwelling. A structure
containing one dwelling unit." (Tigard Municipal Code 14.16.070(b)). By definition alone, adult foster
care homes should not be part of this proposed ordinance. Adult Foster Care Homes are the second most
regulated senior care industry in the state, only behind nursing homes. We have to adhere and comply
with 61 pages of regulations, which include such areas as:
Definitions; purpose, license required; capacity; license application and fees, criminal record clearance;
training requirements; classification of home; general condition (zoning, codes, fire and safety
regulations); condition of furnishings; stairways, railings; heating system; minimum amount of common
living space; size of interior doorways; swimming pool/spa/sauna safety; first aid; sanitation
(water/plumbing/sewer/garbage); laundry; household pets; universal precautions for infection control;
bathrooms (individual privacy); bedroom size and who can or cannot occupy the bedrooms; size of beds;
bedding requirements; furniture requirements in the bedroom; proximity of the bedrooms to the provider;
location of bedrooms; meals (how many, when) food preparation; telephone availability; safety (fire);
heating; hardware for all doors; window sizes; construction; flame spread requirements; mobile home
requirements; fire extinguisher requirements; smoke detector requirements; emergency evacuation plans;
orienting employees and residents to the home; width and size of common areas; location in relation to
closest fire station; flashlight requirements; smoking regulations; natural disaster plans; standards and
practices for care and services; admission; assessment and care plans; medications; treatments; therapies;
psychoactive medications; physical restraints; registered nurse consultation; resident care; resident
records; financial records; residents' bill of rights; house rules; inspections by licensers; complaints;
procedures for correction of violations; administrative sanctions; denial, revocation or non-renewal of
Page 2
Community Housing Task Force
City of Tigard
August 6, 1998
license; suspension of license; conditions to a license; criminal penalties; civil penalties and last, but not
least, zoning requirements. Sitting in front of me is the "Ensuring Quality Care (EQC)" binder which is
the `Bible" for adult foster home providers. These are the rules, forms and guidelines for us and our
residents. I have also brought several copies of the Administrative Rules for the Task Force if any
member or City of Tigard staff person would like a copy.
We have families, nurses, social workers, licensers, inspectors, referral agencies, and Ombudsmen coming
to our homes to visit our residents and tell us what to do. We have SDSD in Salem and Washington
County Aging and Veterans Services offices overseeing us and telling us what to do. Without being
rude, we really do not need one more set of rules or another governmental agency to oversee us. There
are 37 adult foster homes in Tigard, which serve approximately 180 seniors. We are proud of the work
we do, but please, do not add more paperwork and other regulatory agency to our already busy,
overregulated industry. We respectfully request that adult foster care homes be deleted from this draft
ordinance and not be included as a"Social Care Facility"in the City's ordinance.
Thank you for your time and consideration to this issue.
Page 3
ACPO
Adult Care Providers of Oregon
Washington County Chapter
15405 SW 116th Ave., Suite 103-A,King City,OR 97224
Office: 503 684-1800 Fax: 503 684-5828
August 7, 1998
David Scott
Building Official
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
RE: Community Housing Task Force
Adult Foster Care Homes
Dear David:
Thank you for the opportunity to appear before the Community Housing Task Force. Hopefully, I was
able to enlighten those members present about adult foster care homes in Tigard.
Per your request regarding current regulations concerning the general exterior condition of adult foster
care homes, the following addresses that issue. This can be found on page 24 of the "Administrative
Rules for Licensure of Adult Foster Homes", a copy of which was provided to each Task Force member
in attendance as well as yourself.
"411-50-445 Facility Standards
In order to qualify for or maintain a license, an adult foster home shall comply with the following
provisions:
(1) General Conditions
(a) Each adult foster home shall meet all applicable local business license, zoning,
building and housing codes, and state and local fire and safety regulations for a
single family residence;
(b) the building and furnishings shall be clean and in good repair. Grounds shall be
well maintained. Walls, ceilings, and floors shall be of such character to permit
frequent washing, cleaning, or painting. there shall be no accumulation of garbage,
debris, rubbish or offensive odors;"
David Scott
August 7, 1998
Page 2.
This section clearly states that each adult foster care home in Tigard must comply with all regulations
regarding single family dwellings. Therefore, any existing or proposed regulations regarding the upkeep
of the exterior or yard of a single family residence in Tigard would automatically apply to all adult foster
care homes in Tigard.
You commented yesterday that your initial, preliminary staff recommendation would be to exclude
Building Code 'T' facilities (typically nursing/convalescent) from the proposed ordinance, but be more
concerned about facilities as you go "down" the chain, getting closer to "R3" or single family dwellings,
or adult foster homes. If you will compare the rules that you were given for assisted living facilities,
residential care facilities and adult foster care homes, you will clearly see that adult foster care homes are
much more stringently regulated than either of the other two, and they have far more regulations already
in place with which to comply. Consequently, I would propose that you review these regulations
carefully and possibly rethink your preliminary staff recommendation.
Again, ACPO appreciates the opportunity to take part in this important evaluation of "Social Care
Facilities" in Tigard. Please do not hesitate to contact me if you need any further information. I look
forward to hearing from you in the near future with the date for the next Task Force meeting.
Sincerely,
Jun ulffndge
President
ACPO -Washington County Chapter