Facility Evaluation Report

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.