Masonic Home for Adults

Type of visit: Case Management - Incident

On 8/27/2026 at 11:30 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez, and explained the reason for the visit. On 8/18/26, LPA K. Nguyen received an Unusual Incident report regarding a medication error. LPA interviewed ED regarding the medication error. ED stated that R1 was given a medication the PCP instructed to be given three times a week; however, the medtech gave R1 the medication three times a day. LPA conducted a file review, including but not limited to the MAR, medication orders, and lab reports, which show no cause or damage to R1, and the ED stated that the ED spoke with the resident and has had staff monitor R1 for 7 days. The facility confirmed that the resident is doing well and is receiving regular check-ups with the resident's PCP. The facility had conducted an in-house investigation. ED stated that the facility has conducted in-house training on medication errors for all medtechs and continues to provide training. The facility has taken action and is following its protocol to prevent future medication errors. ED will implement a plan for monthly medication training, including topics and attendance, and provide it to CCLD for the next three months. No deficiencies were cited during today's visit. An exit interview is conducted and a copy of the report.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Case Management - Other

On 08/27/2026 at 10:30 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit to deliver an Exemption Denial letter. LPA met with Executive Director (ED), Soledad Martinez, and explained the purpose of the visit. During the visit, LPA hand-delivered the Exemption Denial letter for S1 to Soledad Martinez. The Executive Director (ED) stated that S1 is not currently employed at the facility and will be removed immediately from the facility's Guardian Roster. ED submitted the confirmation of removal letter today, 8/27/26. No deficiencies are being cited on this date.the state’s words, verbatim · CDSS document, Aug 27, 2026

Allegation investigated: Lack of supervision resulting in financial abuse of resident

On 6/5/2026 at 8:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Executive Director, Soledad Martinez, and explained the purpose of the visit. During the course of the investigation, the Licensing Program Analyst (LPA) conducted interviews with Resident 1 (R1) and Staff 1 (S1). In addition, the LPA obtained and reviewed relevant records, including but not limited to R1’s Face Sheet, Care Agreement, Uniform Statutory Power of Attorney, Application for Masonic Homes/Masonic Outreach Services (RCFE), Admission Agreement, Physician’s Report (LIC 602A), and Personal Rights documentation. Report continued on LIC 9099c… Unsubstantiated Report continued… It was alleged that the facility failed to provide adequate supervision, resulting in the financial abuse of residents. As part of the investigation, the LPA interviewed R1 regarding the alleged financial exploitation. R1 stated that all financial transactions in question were initiated and authorized by R1. Specifically, R1 reported, “I am the one who made those transactions and am fully aware of them. I am my own conservator and do not have a Power of Attorney. I keep track of all my financial transactions on my laptop. I made those transactions to help one of my friends. No one is financially abusing me.” A review of the records obtained during the investigation did not reveal evidence indicating that the facility, its staff, or any other individual associated with the facility had access to or control over R1’s finances. Documentation reviewed further supported that R1 retained authority over personal and financial decision-making and had not designated a Power of Attorney to manage financial matters on R1 behalf. Based on interviews conducted and records reviewed, the investigation did not produce sufficient evidence to support the allegation that the facility lacked supervision, resulting in the financial abuse of residents. Although the allegation may have occurred or may be valid, there is no preponderance of evidence to establish that a violation occurred. Therefore, the allegation that the facility lacked supervision, resulting in financial abuse of residents, is UNSUBSTANTIATED. Exit interview conducted. A copy of this report is provided.the state’s words, verbatim · CDSS document, Jun 5, 2026 · control 15-AS-20260603090038

Type of visit: Case Management - Incident

On 6/5/2026 at 11:30 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez, and explained the reason for the visit. LPA received a UIR regarding a resident who suffered a fall and was admitted to the emergency on 4/10/26, resulting in a closed fracture of the distal end of the right fibula and a foot fracture. LPA interview: S1 confirmed that R1 is a resident at Masonic in independent living and reviewed the resident's file, including, but not limited to, the roster for RF, identified as the resident's roster for independent and assisted; the admission agreement; physician report; appraisal; medication test; and care note. R1 returns to the community on the same day as R1 admission. No deficiency cited on today's visit. An exit interview is conducted, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Jun 5, 2026

Type of visit: Case Management - Incident

On 6/5/2026 at 12:30 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez, and explained the reason for the visit. LPA received a UIR regarding a resident who suffered a fall and was admitted to the emergency on 5/2/26, resulting in a fracture of the femur. LPA interview: S1 confirmed that R1 is a resident at Masonic in independent living and reviewed the resident's file, including, but not limited to, the roster for RF, identified as the resident's roster for independent and assisted; the admission agreement; physician report; appraisal; medication test; and care note. R1 returned to the community and was admitted to skilled nursing for recovery on 5/9/26 and remains there to present. No deficiency cited on today's visit. An exit interview is conducted, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Jun 5, 2026

Type of visit: Case Management - Incident

On 6/5/2026 at 1:00 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez, and explained the reason for the visit. LPA received a UIR regarding a resident who suffered a fall and was admitted to the emergency on 5/1/26, resulting in a Subdural Hematoma. LPA interview: S1 confirmed that R1 is a resident at Masonic in level 2 assisted living. LPA reviewed the resident's file, including, but not limited to, the roster for RF, identified as the resident's roster for independent and assisted; the admission agreement; physician report; appraisal; room safety check dated 4/14/26 indicated preventative change to assist R1 due to R1 is fall risk, and care note. Documents reviewed indicate that on the day of the fall R1 sated to one of the staff explained why R1 fell. Noted in care note on 5/1/26 R1 "I try to go to bed by myself when I was near the bed, I lost my balance and fell. I hit my head on the floor after that I call for help". R1 returned to the community and was admitted to skilled nursing for recovery on 5/1/26 on the same day. LPA was informed that R1 never made it back to the community because R1 had passed away on 5/20/26 while in Skill nursing. No deficiency cited on today's visit. An exit interview is conducted, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Jun 5, 2026

Type of visit: Case Management - Incident

On 6/5/2026 at 1:30 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez, and explained the reason for the visit. LPA received a UIR on May 26, 2026, at approximately 2:00 pm. Memory care resident R1 was taken to an on-site appointment by S2, informing the nurse that R1 had left the appointment office. LPA confirmed with S1 that R1 never left the community. R1 walked outside the office building and was found by a staff member within 15 minutes. S1 stated that an internal investigation had found miscommunication between staff. An in-service training session has been conducted on the importance of monitoring residents and not leaving them unattended in the memory care unit. No deficiency cited on today's visit. An exit interview is conducted, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Jun 5, 2026

Type of visit: Required - 1 Year

At around 10:00AM, Licensing Program Analysts (LPAs) K. Nguyen and L. Alexander arrived unannounced to conduct an annual required inspection and met with Back up administrator Gladys Nulph hold an administrative certificate: 7017770740 effectives 9/27/25 to 9/26/27. Executive Director, Soledad Martinez was not available at the time of visit. This facility is a Continuing Care Retirement Community (CCRC). The facility provides independent, assisted living and memory care. LPAs with Gladys inspected the following: total of 5 rooms in independent living, assisted living and memory care, kitchen, dining area, activity room and other common areas. All showers/bathrooms were observed with bars and non-skid floors. Multiple fire extinguishers were observed in different locations that appear full and were inspected on 01/05/26. LPAs observed sufficient supply of perishable and non-perishable foods. Hot water temperature measured at 106.8 degrees Fahrenheit in different rooms checked. Memory Care unit has a delayed egress system that was observed functional. Maintenance log for facility generator indicates last weekly inspection was conducted on 12/23/2025 and last monthly test was done on 12/30/2025. Facility has a current disaster plan and supplemental emergency disaster plan dated 11/13/2025. First aid kit was observed complete. Last disaster drill was conducted on 1/23/2026 (lasted 5 days). Liability insurance effective date from 4/1/2025 to 4/1/2026. Reports continued on LIC 809c… LPAs inspected the Wollenberg Building which has 30 Memory Care residents, and Pavillion Building which consist of all AL residents. LPAs reviewed 12 staff and 14 resident files 12 out of 12 staff have health clearance on files. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: · At 1:36 PM during touring of the facility LPA observed assisted living R1's have unlocked medication inside R1’s bathroom cabinet including but not limited to Calcium Antacid, Selenium and Tylenol. · At 1:37PM during touring of the facility LPA observed assisted living R1's have unlocked chemical inside R1’s bathroom cabinet including but not limited 70% Isopropyl Alcohol. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 24, 2026

Type of visit: Required - 1 Year

At around 10:00am, Licensing Program Analysts (LPAs) K. Nguyen and Lori Alexander arrived unannounced to conduct an annual required inspection and met with Executive Director, Soledad Martinez. This facility is a Continuing Care Retirement Community (CCRC). The facility provides independent, assisted living and memory care. LPAs with Soledad inspected the following: total of 20 rooms in independent living, assisted living and memory care, kitchen, dining area, activity room and other common areas. All showers/bathrooms were observed with grab bars and non-skid floors. Multiple fire extinguishers were observed in different locations that appear full and were inspected on 01/09/2025. LPAs observed sufficient supply of perishable and non-perishable foods. Hot water temperature measured at 110.1 degrees Fahrenheit in different rooms checked. Memory Care unit has a delayed egress system that was observed functional. Maintenance log for facility generator indicates last weekly inspection was conducted on 2/11/2025 and last monthly test was done on 1/24/2025. Facility has a current disaster plan and supplemental emergency disaster plan dated 1/9/2024. First aid kit was observed complete. Last disaster drill was conducted on 1/16/2025 and 1/23/2025 (lasted 5 days). Liability insurance effective date from 4/1/2024 to 4/1/2025. LPAs inspected the Wollenberg Building which has 30 Memory Care residents, and Pavillion Building which consist of all AL residents. LPAs reviewed 13 staff and 15 resident files. LPA reviewed 13 staff files 13 out of 13 staffs have health clearance on files. No deficiencies were observed in the areas that were evaluated. No citations were issued during today’s inspection. Exit interview conducted and a copy of this report provided via email to Executive Director.the state’s words, verbatim · CDSS document, Feb 14, 2025

Allegation investigated: Facility staff are preventing resident from leaving the facility

On 11/26/20224 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Memory Care Manager Deanne Rehberg, and explained the purpose of the visit. During the course of the investigation, LPAs interviewed W1, S1,R1 and reviewed R1s file. LPAs also toured the memory care unit. Documentation in R1s file showed that R1 was admitted to the facility on 09/13/2024 with diognosis of dementia as documented on the physician report dated 07/23/2024. By reviewing the physicians report, LPAs observed that the physician statead that R1 cannot leave the facility unassisted. R1 is currently residing in the memory care unit at the facility.R1 was transferred from another Masonic Facility due to exhibiting dangerous behavior. That faciility deoes not have a memory care unit so was not able to meet R1's increased level of care. **REPORT TO CONTINUE ON 9099 C** Unsubstantiated **REPORT CONTINUED FROM 9099** LPAs interviewed S1. S1 stated that she has worked at the facility for about one year and has known R1 since R1 was admitted to the facility. S1 further stated that she well aware of R1's desire to move back to southern California and that R1 does not accept the fact that she has the diagnosis of Dementia. S1 stated that from time to time, she is able to get R1 to participate in the activities at the facility and that R1 seems to enjoy herself during that time. S1 stated that she feels that R1 is appropriately placed in the memory care unit.. LPAs interviewed R1 who stated that she is very unhappy and she wants go back to southern California to be with her friends. R1 does not think that she needs to live in Memory Care. R1 further stated that she is very unhappy with the fact that she was moved here against her will and feels like she should be able to determine where she lives and with who. R1 would like to live with a friend she has in southern California. LPAs interviewed W1 who stated he has known R1 for about four years. He lived at the same facility as R1 in southern California. W1 stated that R1 was recently diagnosed with dementia, and her driver license was taken away and needed a higher level of care that was not available at the facility in Southern California. W1 stated that he is very happy with the level of care that R1 is receiving at her current facility. W1 also knows that R1 is not happy and and refuses to accept that she has dementia and needs a higher level of care. This agency has investigated the complaint alleging facility staff are preventing resident from leaving the facility. We have found that the complaint was unsubstantiated. 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. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 15-AS-20241119151951

Type of visit: Case Management - Incident

On 10/31/2024 at 9:15AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED), Soledad Martinez and explained the reason for the visit. LPA received a SOC 341 regrading a self-reporting from R1 stated R1didn’t want to stay at the facility. R1 stated R1 was placed at the facility without knowing. Previously R1 resided at Clear Water in Southern California. R1 have a POA (friend) that is 75-year-old. LPA interview R1 regrading the SOC 341 received on 10/28/24. R1 stated R1 feel bored at the facility and missed R1 friend a lot. R1 felt abandon by R1 friend, and just want to stay with R1 friend in Southern California at R1 previous facility. R1 stated “feel safe, staff are not mis-treating R1, but they are boring”. When asked R1 knows that R1 is residing at Masonic, but just want to go back to Southern California. During the interviewed session LPA observed that R1 forgets what R1 was saying, and repeats alot. R1 physician report states R1 diagnose with dementia/ short term memory. According to ED R1 previous facility do not have a memory care unit, also R1 does not like Clear Water, and that's the reason why R1 is placed here by POA. LPA reviewed R1 files including but not limited to physician report, ID notes, and Health Care POA. No citation issue on today date. Exit interview is conducted and a copy of this report is provided to ED.the state’s words, verbatim · CDSS document, Oct 31, 2024

Type of visit: Case Management - Other

On 7/17/2024 at 10:15AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a case management visit. LPA met with Vice President of Clinical Services, Chris Gershtein and explained the reason for the visit. Executive Director Soledad Martinez was no available during the time of the visit. LPA received a UIR regrading a resident got admitted to SNIF due to wound care. LPA interview S1, review resident files including but not limited to admission agreement, physician report, updated appraisal needs, and care note including home health care notes. Resident is on a CCRC contract. Resident was in SNIF in 11/1/23 and graduated back to AL in 12/23/23. During that time when resident was in assisted living home health was assisting resident with wound care. During the time resident wound was at a stage between one and two. This resident has been back and forth with SNIF and RCFE multiple times. This resident has home health that assisting him during the whole duration of the time. LPA interview S1 indicate that this resident was refusing care because he very independent and doesn’t want help from anyone. That’s the reason why he back and forth between assisted and SNIF. According to S1 resident is doing better but is still in SNIF due to his care for wound. Resident wants to be back to assisted living, but S1 indicated he did not pass his room safety check. That’s the routine that facility does for any resident want can be potential to graduate from SNIF. Resident is doing better and is still in SNIF. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided via email.the state’s words, verbatim · CDSS document, Jul 17, 2024

Type of visit: Required - 1 Year

At around 9:00am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with Executive Director, Soledad Martinez. This facility is a Continuing Care Retirement Community (CCRC). The facility provides independent, assisted living and memory care. LPA with Soledad inspected the following: total of 8 rooms in independent living, assisted living and memory care, kitchen, dining area, activity room and other common areas. All showers/bathrooms were observed with grab bars and non-skid floors. Multiple fire extinguishers were observed in different locations that appear full and were inspected on 1/23/2024. LPA observed sufficient supply of perishable and non perishable foods. Hot water temperature measured at 118 degrees Fahrenheit in different rooms checked. Memory Care unit has a delayed egress system that was observed functional. Maintenance log for facility generator indicates last weekly inspection was conducted on 2/27/2024 and last monthly test was done on 2/27/2024. Facility has a current disaster plan and supplemental emergency disaster plan dated 1/08/2024. First aid kit was observed complete. Last disaster drill was conducted on 2/21/2024 and 2/23/2024 (lasted two days). LPA inspected the Wollenberg Building which has 20 Memory Care residents, and Pavillion Building which consist of 4 Memory care residents. Five residents and 4 staff were interviewed. LPA reviewed 4 staff and 8 resident files. LPA reviewed 4 staff files 4 out of 4 staffs have health clearance on files. No deficiencies were observed in the areas that were evaluated. No citations were issued during today’s inspection. Exit interview conducted and a copy of this report provided via email to Executive Director.the state’s words, verbatim · CDSS document, Feb 28, 2024

Type of visit: Case Management - Health Checks

On 1/09/24 at 2:00 PM, Licensing Program Analyst (LPA) Greg Clark conducted a Health & Safety inspection as a result of an email sent to CCL regarding a boiler in one of the facility's buildings being inoperable resulting in no heat in the residents apartments. LPA met with Administrator, Soledad Martinez and explained the purpose of the visit. LPA toured facility including but not limited to 3 apartments, hallway and common areas. LPA also interviewed S1 and 3 residents (R1, R2 and R3). The building without heat is part of the facility's independent living residences. S1 stated that the boiler in still down in the South Building. A replacement part has been ordered and is expected in 3 weeks time at which time the unit will be repaired. S1 further stated that she has keep in communication with the residents in the South Building via memos and has offered them all space heaters and extra blankets. Only 14 of the 36 residents in the building have requested space heaters. LPA interviewed R1 who has a space heater but is not using it. R1 also stated that he feels that the staff at the facility are doing a "great job" keeping the residents informed of the issues with repairs. R2 stated that he has a space heater but only uses it during the daytime hours. R2 also stated that he feels that the staff are keeping the residents informed of the issues with repairs. R3 stated that she has a heater but only used it during the day. R3 thinks the staff are "doing their very best" in dealing with this issue. LPA requested proof of the completed repair work be sent to him via email and documentation that the unit is now functional. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 9, 2024

Allegation investigated: Staff are abusing residents in care Staff are mismanaging resident's medications

On 11/15/2023 at 11:55 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit and deliver findings. LPA explained the purpose of the visit with Executive Director Soledad Martinez. On the allegation facility staff are mismanaging resident's medications. Based on observation, record review and interviews, the facility staff will pre pour residents medications and leave them locked in the medication room. Based on interviews with staff the medications are not pre-poured over 24 hours in advance and are given to the residents the same day they are poured. The residents medication is keep separated and marked to avoid residents receiving the wrong dosage. On the allegation facility staff are abusing residents in care. In an interview with S1they stated that S2 was rude to residents in care. R1 and R2 stated that they did have a disagreement with S1 and brought it to the Continued on LIC9099C... Unsubstantiated ... Continued from LIC9099 attention of facility management. R1 and R2 state that since then all has been well and they feel that S2 work is well and better. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 15, 2023 · control 15-AS-20230628101622