Mograce Residence

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.

Provide resident hot water for personal care

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.

Report specified resident events within seven days

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.

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.

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.

Provide resident hot water for personal care

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.

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.

Maintain facility in clean, safe, sanitary condition

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.

Staff training in personal care activities

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.

Store centrally held medications in locked secure place

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.

Maintain cleanliness and prevent incontinence odors

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.

Keep prescriptions in original containers

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.

Maintain cleanliness and prevent incontinence odors

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.

Store centrally held medications in locked secure place

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.

Safe, healthful, comfortable accommodations

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