Masonic Guest Home

Allegation investigated: Personal Rights

Licensing Program Analyst (LPA) Ethel Contreras arrived at this facility unannounced to conduct an investigation into the above allegation and deliver complaint findings. LPA was greeted by adminsitrator Leonida Lacap. Complaint alleges Personal Rights. Complainant alleges that R1 was struck on the hand as a corrective measure by facility staff. During investigation LPA conducted interviews. 4 out of 4 resident report they have never been hit, slapped, or struck by facility staff. Additionally, all residents interviewed report they have never seen facility staff hit any other residents. LPA also interviewed facility staff. Staff interviewed report they have never hit, slapped, or struck any residents and they have never seen any other staff hit, slap, or strike any residents. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Copy of report given and read with administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2026 · control 21-AS-20251121143502

Type of visit: Required - 1 Year

At approximately 12:15 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Leonida Lacap arrived at 12:30 PM. Masonic Guest Home is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for one (1) resident. Upon arrival, LPA was informed that there were five (5) residents in care and one (1) staff member on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:30 PM, LPA toured the facility with Administrator Lacap. All exits were clear and unobstructed. The Facility's two (2) fire extinguishers were last serviced and tagged on 11/17/2025. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 10/25/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 1:00 PM, LPA reviewed five (5) resident files. Five (5) of five (5) resident files were observed with all required documentation. LPA reviewed two (2) staff files. One (1) of two (2) staff files (for staff member S1) was observed not to have the required annual eight (8) hours of Dementia care training. This deficiency will be cited. One (1) of two (2) staff files (for staff member S2) did not have a staff file at the facility. This deficiency will be cited. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Leonida Lacap’s Administrator Certification 7033434740 is current with an expiration date of 10/14/2027. LPA requested the following documents be submitted to Community Care Licensing by 2/27/2026: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Lacap. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jan 27, 2026

Type of visit: Required - 1 Year

On 01/03/2025, Licensing Program Analyst (LPA) Araceli Canela arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Leonida Lacap and explained the purpose of the visit. This facility is a one story home, licensed for 6 non-ambulatory residents, of which one may receive Hospice services. LPA Canela and administrator toured the facility together and facility was found at a comfortable temperature with all exits free from obstruction. Areas toured include but are not limited to five (5) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. The common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair, with the required grab bars. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored properly and the facility has the required (7) seven-day non-perishable and (2) day perishable supply of food. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged and was last serviced on 9/10/2024. Smoke detectors are all operational. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 7/23/24, the facility has been conducting drills every 3 months. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities Planned for the residents and 3 of the residents attend day program . All required postings are displayed within facility. Staff and resident files were reviewed. Medication is locked in a locked closet. Continue report see LIC809-C Administrator certificate for, Leonida Lacap (cert #6006612740 exp.10/10/2025) is current. LPA went over last visit in August and the facility had a current medical assessment for R1, the items in the backyard were removed and no citations were issued. Licensee/Administrator to submit the current following documents by 1/25/2025: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Copy of Liability Insurance The facility is in compliance. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was emailed to administrator.the state’s words, verbatim · CDSS document, Jan 3, 2025

Allegation investigated: Faciltiy staff are not meeting residents care needs

Licensing Program Analyst (LPA) A Canela arrived unannounced for the purpose of opening a complaint regarding the above allegation for Faciltiy staff are not meeting residents care needs. During todays investigation, LPA made observations, took statements and reviewed documents. It was alleged R1 was found with ants in their diaper; Complainant had no direct knowledge or saw ants in R1's diaper but was made aware. LPA did not get any corroborating statements from staff or residents that were interviewed. LPA did not observe any ants in any rooms, but it was corroborated that the facility had ants in another residents room because of some food left in the room. Although the allegation may be true, or valid, based on LPAs observation and no corroborating statements received from resident or staff interviewed; there is not a preponderance of evidence to prove or, disprove, the allegation. Therefore, the allegation for Faciltiy staff are not meeting residents care needs is UNSUBSTANTIATED. Report emailed. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 9, 2024 · control 21-AS-20240806161716

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Canela arrived unannounced and met with Leni Lacap, Licensee/Administrator. During the course of a complaint investigation, LPA discovered Resident R1 who is diagnosed with Dementia did not have a current Medical Assessment as required. The last medical Assessment was noted as being done on 1/28/2023 and more than a year. R1 did not have a current resident appraisal in file and the last one done was completed, over a year, on 1/24/2023. During todays visit LPA observed 3 twin size mattress/box spring in the backyard and they need to be removed. Facility stated they had placed the extra mattress out to disinfect. LPA also observed several garbage bags on top of a table in the backyard that contained resident R2's clothing and were said to have been washed and put in bags since resident was positive for Covid and they wanted to disinfect the room before they bring the clothes in. LPA requested facility to bring the bags of clothing in as this may be a personal rights violation. LPA consulted with facility regarding some flat electric hair irons that were taken from resident R3 and facility was requested to return items back to resident. Due to computer issues and time restraint, LPA will need to return to issue any citations or advisory notes, from todays visit. No citations issuedthe state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Required - 1 Year

On 01/18/2024 09:30 AM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Leonida Lacap (cert #6006612740 exp.10/10/2025) and explained the purpose of the visit. Administrator certificate is current. LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to six (6) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. The common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a locked closet. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities Planned for the clients. All required postings are displayed within facility. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 10/14/23, the facility has been conducting drills every 3 months. The facility is in compliance. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to administrator.the state’s words, verbatim · CDSS document, Jan 18, 2024