MOGRACE RESIDENCE

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 87303(e)(2)-Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement LPA's measured the hot water in a resident bathroom sink, it was 134.4 degrees Fahrenheit, which is above regulation compliance, no lower than 105. degrees and no higher than 120.degrees, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/21/2026 Plan of Correction Licensee/Administrator turned down the hot water heater during the inspection. Licensee/Administrator to ensure they have the ability to have temperature controls to automatically regulate the temperature of hot water to be in compliance, and maintained, within regulation. Hot water log to be maintained to 1/28, showing hot water temperature within regulation-submit the log by 1/28/26. Submit plan of corrction by 1/21/26.

Official classification

Type B

Official code

87407(d)

Regulation authority

CCR

What the official deficiency says

87407(d) Administrator Recertification Requirements-To apply for recertification prior to the expiration date of the certificate, the certificate holder shall submit to the Department’s Administrator Certification Section, post-marked on, or up to ninety (90) days before, the certificate expiration date. This requirement is not met as evidenced by: Deficient Practice Statement Based onper LPA's review. Licensee/Administrator's certificate expired 4/2025; Licensee showed training completed for administrator recertification that they state was sent into the Department. Licensee/Administrator was not in the administrator application renewals list, in the active certificates or the pending certificates on the " administrator certification unit website, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/26/2026 Plan of Correction Licensee/Administrator to submit all required trainings for their administrator recertification, and pay fee, including any late fees per submission. Submit proof that the documents were submitted to the administrator certification unit as required. Submit plan of future compliance and ensuring timely recertification as required by regulation. POC due 1/26/26

Official classification

Type A

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements 87211(a)(1)- Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case, This requirement was not met as evidenced by: Per facility file review, and department record review, and interviews, there were no written reports to the Department as required, regarding resident incidents, 12/19/23, 3/23/24, and 5/27/25, including a report of the passing of R1, 6/2025. This is a risk to health & safety of residents in care.

Official plan of correction

Licensee/Administrator to ensure to procide the written incident reports of 12/19/23, 3/23/24, 5/27/25, and death report of 6/2025. Submit plan of future compliance with this regulation. POC due 8/7/2025.

Deadline recorded: Aug 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's record reviews, and interviews, Administrator could not provide proof of having completed emergency disaster quarterly drills as required, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/28/2025 Plan of Correction Licensee/Administrator to submit plan of correction to ensure the facility is/will conduct the required quarterly drills. Submit a completed quarterly drill with all staff, include all required documentation of the drill. Submit plan of required future annual drills to be completed as required. POC due 2/28/2025.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation Section 87303(e)(2) - Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement LPAs checked the hallway resident bathroom's hot water, and it was checked at 169.9 degrees Fahrenheit; This is not within regulation of no lower than 105. Degrees Fahrenheit or no higher than 120. degrees Fahrenheit., the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Licensee/Administrator turned down the hot water heater. Licensee will ensure the hot water is no lower than 105. degrees Fahrenheit and no higher than 120 degrees Fahrenheit. Submit a copy of the hot water check log of five days, 2/25/25, ensuring it is within compliance. POC due 2/20/2025.

Official classification

Type A

Official code

87307(f)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services 87307(f) -The licensee shall supervise residents as needed and as determined by the resident's appraisal, pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to birdbaths, fountains, or similar smaller decorative water features. This requirement is not met as evidenced by: Deficient Practice Statement LPAs observed an area in the backyard where it is filled with various size rocks, and it was flooded making it a small pond/water feature. Water was no longer draining out of this rock filled area. This has never been observed this way prior to today's inspection. The water is at a level where it may be a risk to the health & safety of residents in care.], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/20/2025 Plan of Correction Licensee/Administrator to ensure that all staff are monitoring residents as needed and redirecting residents as needed to ensure their needs are met regarding keeping the backyard rock filled water small (pond liike) water feature. Administrator stated they will unclog this area and drain it as needed, it is not meant to be a water feature. Submit plan of ensuring residents health & safety regarding the above, and plan of correction. POC due by 2/20/25.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation- The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. LPA observed that the living room slider door has a broken lock, when the slider is in lock position it still opens up. This is a risk to the health and safety of residents in care.

Official plan of correction

Licensee/Administrator to ensure the lock on the living room slider door is repaired and/or replcaced so the lock works as it should. The living room slider door should lock appropriately, and be secure, for all residents residing in the facility. Submit receipt of purchase of new lock and materials and submit written confirmation that the door is working/locking appropriately as it should. POC due 9/11/24.

Deadline recorded: Sep 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)(b)

Regulation authority

CCR

What the official deficiency says

87506(a)(b) Resident Records-The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Each resident’s record shall contain at least the following information, see regulation. This requirement was not met as evidenced by: Per interviews and resident record requests, R1 lacks admittance documents as required per regulation, no records on-file/on-site for R1. This is a risk to personal rights and/or a risk to health & safety of residents.

Official plan of correction

Licensee/Administrator to ensure that all required documents for admitting residents into the facility are completed, signed/dated as needed, onsite at the facility, and available for review as required. POC due 9/16/24.

Deadline recorded: Sep 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411(c) Personnel Requirements – General- All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met as evidenced by: Per interviews, and record requests, S2 lacks required staff training for direct caregivers, the 40 initial required training hours. Staff S2 has worked approximately six (6) months. This is a risk to personal rights and/or a risk to health & safety of residents.

Official plan of correction

Licensee/Administrator to ensure S2 obtains required RCFE 40 hour training. Submit proof of training, meeting all H & S code 1569.625 and 1569.69 training requirements (specific training/specific number of hours). POC due 9/30/24.

Deadline recorded: Sep 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's (observation) R1's bedroom smells strongly of urine odor, and is smelled in the hallway outside resident's bedroom door, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/12/2024 Plan of Correction The Administrator stated that they will make a change in resident's room, cleaning flooring/carpet and/or newer carpet or flooring due to the continued concern of the urine odor. Administrator will submit POC by 1/12/24. Note: Submit Follow-up by 1/29/24, with completion date of correction, what was done, and maintenance plan on future compliance with this regulation.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations of medication bottle on resident (R1's) night stand. The medication should be centrally stored as required by regulations, the licensee did not comply with the section cited above, which poses an immediate health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/05/2024 Plan of Correction Facility to ensure all medications are centrally stored and inaccessible to residents in care; Medications are to be accessible to staff trained to assist residents with medications, per regulation. Centrally store all of R1's medications, and submit how you have completed this, and future plan of compliance. POC due by 1/5/24.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2)The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: LPA's observations of medication bottle on resident(R2's) night stand. The medication shoud be centrally stored as required by regulations. This is a risk health & safety and/or a personal rights risk to residents in care.

Official plan of correction

Facility to ensure all medications are centrally stored and inaccessible to residents in care. Sbmit policy and procedures regarding storage of medications. POC due 3/10/23.

Deadline recorded: Mar 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence (b)(3) (b)In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3)Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: LPA's observations, R2's room smells strongly of urine, the resident is incontinent. LPA could smell the urine odor upon entering the facility to conduct the visit. The room needs to be cleaned and free from urine odor. This is a risk to personal rights of residents in care.

Official plan of correction

Facility to ensure the resident room is free from urine odors, including the faciity's other areas of the home. Facility to clean the resident room and ensure continued maintenance of the room to keep the facility free of urine odor. POC due 3/17/23.

Deadline recorded: Mar 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

87465(h)(5) Incidental Medical and Dental Care -(h)The following requirements shall apply to medications which are centrally stored: (5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: LPA observed the resident medications had been prepoured into plastic containers which were to be given to the residents as stated. Medications are to remain in original containers. This is a potenitial risk to health & safety and/or personal rights risk to residents in care.

Official plan of correction

Facility to ensure that medications are not transferred between containers at any time, per egulation medications are to remain in origianl containers. Licensee to ensure all staff are retrained in medication procedures, submit proof of training by 3/24/23. Licensee to submit policy and procedures regarding storage of medications, submit plan of correction by 3/10/23.

Deadline recorded: Mar 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights 87468.1(a)(2)- Residents in assisted living.-ensuring personal rights are not violated at any time. This requirement was not met as evidenced by: LPA's observations of two caregivers not wearing masks and walking around the facility and providing needs to a resident in the living room. Staff are to wear masks as required by the Mask Mandate Order from Public Health Dept. This is a risk to health & Safety and/or to personal rights to residents in care

Official plan of correction

Licensee to ensure the staff wear masks at all times as required by the mask mandate order by Public Health Dept. Submit plan of correction of how the facility will be in future compliance with the mask mandate. POC due by 3/10/23.

Deadline recorded: Mar 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

Criminal Record Clearance- 87355(e)(1)- All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA's review of staff associations list from Departments LIS Data Base, and review of DOJ Fingerprint Lists/Clearance Information in the Guardian website.Licensee stated to the LPA that she did not follow-up on Susan Nyambura's fingerprinting documentation and/or ensure she had fingerprint clearance. This is a personal rights/Health and Safety violation and risk to all residents in care. An immediate Civil Penalty will be assessed in the amount of $500-see LIC421BG.

Official plan of correction

Licensee/Administrator stated her understanding of the regulation and information stated above. Licensee to submit facility policy and procedures regarding hiring staff and fingerprint clearance requirements, and plan in ensuring compliance with the regulation. POC due 12/24/21.

Deadline recorded: Dec 24, 2021. A deadline is not proof that correction was completed.