Routine inspection·December 23, 2021

Licensing Program Analyst (LPA), Dina Alviso, arrived unannounced to conduct a Required- 1 Year inspection, and met with a caregiver on duty, Susan Nyambura. Licensee/Administrator Monicah Gacegu arrived to the facility after the caregiver contacted her to notify her of the LPA's arrival. The inspection will focus on the Infection Control procedures and practices of this facility. LPA checked employee fingerprint clearances, and observed that Susan Nyambura was not on the list of associated staff for Mograce Residence; LPA also checked the Guardian Fingerprint Database, and there was no fingerprint information found on a "Susan Nyambura". The Licensee questioned Susan Nyambura on when, and if, she had fingerprinted. LPA discussed regulation 87355 Criminal Record Clearance with the Monicah, Licensee/Administrator. The LPA discussed with the Licensee/Administrators responsibility to ensure compliance with this regulation in hiring staff, and ensuring all staff have DOJ clearance as required before coming into the facility , and working in the facility. The violation will be cited today, Criminal Record Clearance 87355 (e)(1)-see LIC809D. An immediate Civil Penalty will be assessed today, in the amount of $500.- see LIC421BG. Susan Nyambura left the facility immediately; Licensee understands that Susan Nyambura is not to return to work or be on facility premises until obtaining a criminal record clearance and/or criminal record clearance exemption. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. Mitigation plan was reviewed by the Department on 3/16/21. Fire clearance is approved for eight(8) non-ambulatory residents.-effective 8/9/2019. There were 5 residents in care at the facility during this inspection. One resident is on Hospice Care Services. Per Licensee, four(4) staff are fully vaccinated, and Boosters are scheduled. All visitors, essential visitors, and staff are screened upon entry; Temperatures are taken, and screening questions are to be answered before being allowed to remain in the facility, all information is logged. Residents are screened twice daily, and observed for any changes, all information is logged. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Residents have masks available to them for their use if needed and/or wanted. Administrator stated that staff wear masks in the facility, and also when providing care services to the residents in and out of the facility. Administrator had a mask on during the LPA's inspection. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.