Mograce Residence

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Alviso conducted a continued annual inspection, on 1/20/26 at approximately 1:55pm, and met with Administrator Monicah Gacegu. Fire clearance is approved for eight (8) non-ambulatory only. Currently there are five (5) residents' in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. LPA reviewed five (5) resident files, including storage of medications and medication records. All files were complete. LPA reviewed resident's hospice file, including medication orders. LPA reviewed three (3) staff files, including training. All staff have required criminal record clearance. All staff have first aid and CPR certification. LPA toured the facility with Licensee Monicah Gacegu. The LPA observed that the facility was at a comfortable temperature during the inspection. The facility had a sufficient supply of food. There is a cabinet in the kitchen to lock all medications and make them inaccessible to residents in care. Disinfectants/cleaners were locked up and inaccessible to residents in care. Facility had a sufficient supply of paper products, linens, soap, sanitizer, hygiene products, and personal protective equipment (PPE). There was sufficient lighting in hallways, resident rooms, bathrooms, and common areas. Bathrooms had grab bars, and non-skid mats for the shower for residents' use. Facility had sufficient furnishings for resident use. All facility utilities were on, and working as required. Continued on LIC809C.. The backyard fire gates on each side of the yard were clear and unobstructed as required. All walkways were clear. LPA observed the following deficiencies during the inspection: Licensee/Administrator's certificate expired 4/2025, and they were not able to provide a current certificate/a renewal of the certification. Administrator showed copies of their classes they had completed back in April 2025, but there is no record of the classes in the administrator certification unit website, per LPA's review. Licensee/Administrator was not in the administrator application renewals list, in the active certificates or the pending certificates. LPA provided the website link, including the application portal, for administrator certification renewals. This deficiency will be cited, 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, see LIC809D. LPA measured the 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. 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). Deficiencies 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 with Administrator Monicah Gacegu. Appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 20, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year visit, on 1/14/26 at approximately 1:00pm, and met with Administrator Monicah Gacegu. Fire clearance is approved for eight (8) non-ambulatory only. Currently there are five (5) residents' in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. LPA reviewed five (5) resident files, including storage of medications and medication records. All files were complete. LPA reviewed resident's hospice file, including medication orders. LPA reviewed three (3) staff files, including training. All staff have required criminal record clearance. All staff have first aid and CPR certification. The annual will be continued at a later date by the Department. LPA is requesting the following documents be updated and submitted by 2/14/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan, 9pg - (review & update as needed--submit if changes) Infection Control Plan- (review & update as needed--submit if changes) Copy of LIC400- Handling of Client Cash Resources-all care homes complete this form. Copy of surety bond (if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator certificatethe state’s words, verbatim · CDSS document, Jan 14, 2026

Allegation investigated: Staff did not submit required reports to the licensing agency

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/6/25 at approximately 9:40am, and met with Administrator Monicah Gacegu. Reporting party alleges that "staff did not submit required reports to the licensing agency". LPA reviewed resident (R1) records, including admission documents, medical assessment/diagnosis, medication records, and medical documentation. LPA reviewed hospital records obtained during the investigation regarding R1 and incidents that occurred. LPA conducted interviews with staff and other related parties. The investigation revealed R1 was admitted 11/7/2023. Per review of medical records assessment, resident was a fall risk, and used a walker for help with mobility. Per record reviews, and interviews with staff, S1 and S2, resident (R1) was assisted with care needs, and ambulating in the facility, ensuring resident used their walker, with staff assisting as needed. Continued on LIC9099C.. Substantiated Continued from LIC9099, dated 8/6/2025.. Per review of hospital records provided to the LPA, R1 went out by 911 to the hospital on 12/19/23 for abdominal pain, 3/23/2024 for a fall resulting with a head injury, and on 5/27/25 for a fall resulting in a fracture. Resident had been hospitalized and receiving medical care for the fracture; Resident passed in the hospital 6/2025. Per facility file review, and department record review, there were no written reports to the Department regarding the above listed dates of resident incidents, 12/19/23, 3/23/24, and 5/27/25, including a report of the passing of R1, 6/2025, as required. There was sufficient information obtained to support that a violation had occurred regarding the allegation. The investigation, review of records, and interviews with staff, and other parties, finds that the facility failed to report incidents to the department as required by regulation. This deficiency will be cited, 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, see LIC9099. The LPA reviewed regulation 87211 Reporting Requirements, with the Licensee/Administrator Monicah,Gacegu, and the importance of compliance with this regulation at all times. Licensee/Administrator stated their understanding of the above. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Monicah Gacegu. Appeal Rights Provided.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 21-AS-20250707142039

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 7, 2025

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.the state’s words, verbatim · CDSS document, Aug 6, 2025

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.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Alviso and Contreras arrived unannounced to conduct a Required -1 Year inspection, on 2/19/25 at approximately 12:20pm, and met with caregivers Ann and Fredah. Staff contacted Administrator Monicah Gacegu and notified them the LPAs were at the facility. The Administrator arrived to meet with the LPAs. Fire clearance is approved for eight (8) non-ambulatory only. There were seven (7) residents in care at the facility during the inspection. ` Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. LPAs reviewed seven (7) resident files, including storage of medications and medication records. LPAs reviewed three (3) staff files, including training. All staff have required criminal record clearance. LPAs toured the facility with the caregiver Fredah; LPAs toured the facility with the Administrator when they arrived. LPAs observed cleaners/disinfectants locked and inaccessible to residents in care. All medications were locked and inaccessible to residents in care. All exits were free and clear of obstructions. There was a sufficient supply of perishable and non-perishable food. There was a sufficient supply of hygiene products, linens, paper products, and personal protective equipment (PPE) for use as needed. Carbon monoxide detector was working properly during the inspection. All resident rooms and common areas had required smoke alarms. Fire extinguishers was serviced and tagged as required. There was sufficient lighting in the resident rooms, bathrooms, and all common areas. LPA is requesting the following documents be updated and submitted by 3/19/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan- review and if no changes, submit a copy of last page w/signature & Date. If changes, submit a copy of the plan. Continued on LIC809C... Infection Control Plan-review and if no changes, submit a statement w/signature & Date. If changes, submit a copy of the plan. Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash.. Copy of Current Liability Insurance Copy of current Administrator Certificate The following deficiencies were observed by the LPAs: 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 or no higher than 120. degrees Fahrenheit. This deficiency will be cited, 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). LPAs observed an area where it is filled with various size rocks, and it was flooded making it a small pond/small 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. This will be cited, 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 will be cited, Per review of records, Administrator could not provide proof of having completed emergency disaster quarterly drills as required. This deficiency will be cited, Emergency Plans HSC 1569.695(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. Deficiencies 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 with Administrator Monicah Gacegu. Appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year inspection, at approximately 3:58pm on 1/14/25, and met with Administrator Monicah Gacegu. LPA observed a caregiver, Jane Mburu, on duty during the inspection. Caregiver Jane has a criminal record clearance as required, and is associated to the facility. There are currently seven (7) residents in care. The facility is fire cleared for eight (8) non-ambulatory residents. Hospice waiver is approved for three (3) residents. The facility has an approved dementia plan of operation. The facility has a required infection control plan and a required emergency disaster plan. LPA observed some residents in the living room watching television, and other residents were in their private rooms. Staff was preparing the dinner meal for the residents in care. The LPA will continue this annual inspection at a later date.the state’s words, verbatim · CDSS document, Jan 14, 2025

Allegation investigated: Staff are not providing care needs to residents Staff leaves residents in bed for extended periods Staff are not providing activities for residents in care Staff are speaking inappropriately to the resident Staff leaves residents unattended

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 9/9/24 at approximately 1:20pm, and met with caregiver Fridah Kipsenal. LPA spoke with Licensee/Administrator Monicah Gacegu regarding the inspection being conducted today; Licensee/Administrator notified the LPA they were not available to come to the facility at this time, but to call if anything is needed. There are six (6) residents residing in the facility. LPA reviewed six (6) resident records; The LPA requested copies of records. Administrator provided the requested copies to the LPA. LPA reviewed records, and conducted interviews with staff and other related parties. The investigation revealed that R1 moved into the facility per ecord reviews, on 3/9/2024. Resident (R1) is conserved by two (2) conservators, one for the estate, and one for the care of the resident/living situation of the resident. Per interviews with staff, residents needs are met, Incontinent care is being provided as needed and required for all residents that are incontinent, per S1. Continued on LIC9099C... Unsubstantiated R1's needs are met, and resident is provided care services per care plan,Per interviews with staff, the residents are assisted out of bed and brought out of their rooms to the dining table and/or the living room. If a resident says no to getting out of bed, the staff will try again after a few minutes. The residents will usually get up and out of bed for awhile throughout the day as wanted. Staff stated they don't neglect the residents, the residents are cared for. Staff stated that they do activities with the residents getting them up from bed, grooming, feeding, medications, activities and hygiene care. R The facility does have a dementia plan of operation, and is able to care for dementia residents. Interviews with staff, and other related parties, revealed that there are activities offered, and some residents will join in if wanting to. Staff deny that they speak inappropriately to residents in care; Interviews with other related parties, stated the staff don't speak inappropriately to residents. Staff S1 stated they have never left the facility unattended, there is always a staff working. S1 stated they deny ever having left the facility with no staff at any time. The interviews and record reviews didn't provide information that supported violations had occurred regarding the allegations. Per interviews with one of the Conservators, the care home was an emergency placement for R1, and resident was to move out to another facility when it became available. R1 transferred out 5/17/24 to a new facility. It was found that there is differing information obtained in the investigation regarding the allegations that "staff are not providing care needs to residents, staff leaves residents in bed for extended periods, staff are not providing activities for residents in care, staff are speaking inappropriately to the resident, staff leaves residents unattended". There was no information obtained that supported that a violation had occurred. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations are/is Unsubstantiated, meaning that although the allegation (s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator Monicah Gacegu.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 21-AS-20240408145051

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(LPA) conducting a case management visit, at approximately 3:00pm on 9/9/24, and met with Monicah Gacegu-Licensee/Administrator. There are currently six (6) residents in care. This case management is being conducted to address deficiencies found during the complaint inspection of earlier today. The deficiencies are unrelated to the complaint investigation. 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 health and safety risk to residents in care. This deficiency will be cited, 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, see LIC809D. Per interviews and resident record requests, R1 lacks admittance documents as required per regulation, no records on-file/on-site for R1. This deficiency will be cited, 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, see LIC809D. Per interviews, and record requests, S2 lacks required staff training for direct caregivers, the forty (40) initial required RCFE training hours. Staff S2 has worked approximately for six (6) months. This deficiency will be cited, 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, see LIC809D Licensee/Administrator has agreed to submit an updated personnel report, LIC500, of staff schedule, days/hours working, 24/7 staffing. Licensee/to submit copy of R1's appraisal, and copy of R1's care plan, copy of facility activities, and resident roster. Submit the above records by 9/12/24. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited, see LIC809D. Failure to correct deficiencies as required may result in additional citations and civil penalties, including deficiencies re-cited within 12 months. Exit interview conducted. Appeal Rights Given to Monicah Gacegu-Licensee/Administrator.the state’s words, verbatim · CDSS document, Sep 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 11, 2024

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.the state’s words, verbatim · CDSS document, Sep 9, 2024

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.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a)(b) · Plan of correction due date: Sep 16, 2024

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.the state’s words, verbatim · CDSS document, Sep 9, 2024

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.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Sep 30, 2024

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.the state’s words, verbatim · CDSS document, Sep 9, 2024

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.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst(LPA) Alviso conducted a continued annual inspection, at approximately 1:45pm on 1/4/2024, and met with, Administrator Monicah Gacegu. LPA observed two caregivers on duty, Consulata and Pauline. There are currently five residents in care. The facility is fire cleared for eight (8) non-ambulatory. Hospice waiver is approved for three (3). Facility has a dementia plan of operation. The facility has a required infection control plan. Facility has an emergency disaster plan as required. LPA reviewed five (5) resident files. All files were complete. LPA reviewed three (3) staff files, including training. All staff have criminal record clearance as required. All staff have First Aid and CPR certification as required. Staff have required training. The LPA toured the facility with the caregiver Consulata. The bathrooms were clean, all had grab bars, and mats/non-slip flooring for resident use as needed. There was sufficient lighting in the hallways, resident rooms, bathrooms, and in all common areas. Hot water was checked at 117.4 degrees Fahrenheit. Facility has sufficient food supply, hygiene products, paper products, and cleaners. Sufficient supply of PPE. Sufficient emergency supply to meet 72 hour shelter in place requirements. Deficiencies observed that will be cited today, see LIC809Ds. R1's room smelled strongly of urine, and the urine odor can be smelled in the facility's hallway, where R1's room is located. Cited-87625(b)(3) Managed Incontinence) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This is a 2nd citation within 12 months, a civil penalty assessed in the amount of $250-see 421FC Continued on LIC809C... LPA's observations of medication bottle on resident(R1's) night stand. The medication should be centrally stored as required by regulations. Cited-87465(h)(2) 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 is a 2nd citation within 12 months, a civil penalty assessed in the amount of $250-see 421FC LPA is requesting the following documents be updated and submitted by 2/4/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan- review and if no changes, submit a copy of last page w/signature & Date. If changes, submit a copy of the plan. Infection Control Plan-review and if no changes, submit a statement w/signature & Date. If changes, submit a copy of the plan. Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond if handling cash.. Copy of Current Liability Insurance Copy of current Administrator Certificate Deficiencies 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 with Administrator Monicah Gacegu. Appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 4, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Alviso conducting a Required- 1 Year, at approximately 3:30pm on 3/9/23, and met with Monicah Gacegu, Administartor. The caregiver, Consulata, contacted the Administrator to notify them the LPA had arrived. There are currently five residents in care. The facility is fire cleared for eight (8) non-ambulatory. Hospice waiver is approved for three (3). LPA reviewed one of the resident's files. The LPA toured the facility with the caregiver Consulata. The bathrooms were clean and all had grab bars. There was sufficient lighting in the hallways, resident rooms, bathrooms, and in all common areas. The LPA will continue this annual at a later datethe state’s words, verbatim · CDSS document, Dec 21, 2023