Masonic Homes for Adults

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Sanjay Vaid conducted an unannounced annual inspection visit. LPA met with Anabel Mejia Executive Assistant and George Diaz, Director of Facility Services who assisted with the visit. The facility was licensed to serve one hundred & twelve (112) non-ambulatory residents, ages 60 and above. The facility had an approved five (5) hospice waivers. Administrator certificate was current with expiration date on 09/12/2027. Currently there are 57 residents. Zero (0) dementia and zero(0) hospice residents on campus. During the visit, Care Tool was utilized as follows, Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and have an infection Control Plan at facility. Operational Requirements: The facility does accept patients with dementia. There zero (0) bedridden residents residing at the facility. The facility has sufficient liability insurance covering injury to residents and guest. Liability insurance expires 04/01/2027. Physical Plant & Environment Safety: The facility is in a residential neighborhood, consists of three (3) buildings with fifty-six (56) resident apartments. The facility has six (6) administrative offices, a reception area/lobby, beauty salon, wellness center, three (3) libraries, coffee/reading room, hospitality room, dining room, kitchen, mail room, communication room, activity /game room/painting/card making room, general store, housekeeping storage room, computer lab, nurses station, bingo room, exam room, staff lounge, and recovery room. CONTINUED ON 809C...................... CONTINUED FROM 809 There are multiple storage closets/rooms and an indoor/ outdoor activity area. The facility has four (4) residential laundry rooms and a maintenance laundry room. Resident rooms consist of a bedroom, living room, dining area, kitchen, bathroom and walk-in closet. Bathrooms are clean and operable with grab bars and non-skid surface mats/strips. Hot water temperature was in a range of 105.7 to 117.3 degrees Fahrenheit which is within range of 105.0 -120.0 degrees F. Adequate linen and personal hygiene supplies are in stock. Staffing: There appears to be sufficient staffing at the facility. Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Admission Agreements and Physicians reports. Random five residents files were observed. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visiting hours are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Monthly activity calendar and daily activity flyers are handed to residents daily. Food Service: There are sufficient food supplies of 2-day perishable and 7 day non perishable food. The food is properly stored in the refrigerator to avoid cross contamination. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed 5 residents' medication, and the medication is administered according to doctor’s orders. Six (6) residents are currently on oxygen administration. Disaster Preparedness: The facility has an Emergency Disaster Plan. Safety drills are conducted twice per year, last drill was conducted 10/16/2025. Residents with Special Health Needs: There are no residents with special health needs at facility. Zero (0) Deficiencies noted on today’s visit. Exit interview conducted with Anabel Mejia and copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent case management visit in response to an initial Case Management dated 4/14/25 following a Special Incident Report (SIR) that the department received explaining a fracture that Resident #1 (R1) sustained. LPA met with Maria Vasquez and explained the purpose for the visit. On 4/11/25 the department received an SIR dated indicating the following: On 4/10/25 R1 was hospitalized after experiencing an unwitnessed fall, this fall caused resident to sustain a hematoma to the forehead, left wrist, friction burns and fracture. On 4/14/25 LPA obtained copies of the following documents: R1's FACE Sheet, Appraisal Needs & Services Plan/IPP, Physician's Report, Medication List, and discharge paperwork from hospitalization dated 4/10/25. From 4/14/25 - 8/1/25 Investigator D.Douglas, reviewed/investigated this case and it was revealed per the Incident Tracking Report that R1 experienced a total of 32 falls from January 2021 - April 2025 where R1 was either discovered on the floor/ground by staff members/witnesses and sustained a superficial injury as a result of almost falling down. It was also documented that R1 experienced altered consciousness following a fall and occasions where R1 had fallen twice in one day.Therefore, as a result of the information Investigator D.Douglas obtained during the course of the investigation, the allegation of Neglect/Lack of Care and Supervision is Substantiated at this time. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency issued today is documented on 809D. Exit interview held, a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Dec 12, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Per the investigation completed by investigator D.Douglas it was revealed that R1 has experience of falls with injuries, altered consciousness following a fall and occasions where R1 had fallen twice in one day. Which places R1 as a fall risk and had lack of supervion on 4/10/25 when R1 was hospitalized after experiencing an unwitnessed fall, and sustained a rib fracture, right frontal forehead hematoma, and left wrist tenderness with hematoma, following the fall.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: Licensee/Administrator to provide LPA with a copy of updated care plan for R1 that explains what staff will be doing to ensure R1 will be provided with the required care and supervision needed to reduce the amount of falls, including monitoring/assisting R1 when they are using the massage chair. This is to be emailed to LPA by POC due date of 12/12/25. tena.herrera@dss.ca.gov

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Alberto Lopez, Elena Mallett, and Sakinah Madyun conducted an unannounced annual inspection visit. LPA met with Maria Vasquez, Nursing Manager who assisted with the visit. The facility was licensed to serve one hundred & twelve (112) non-ambulatory residents, ages 60 and above. The facility had an approved five (5) hospice waivers. Administrator certificate was current with expiration date on 09/12/2025. Currently there are 56 residents. Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and have an infection Control Plan at facility. Operational Requirements: The facility does accepts patients with dementia There 0 bedridden residents residing at the facility. The facility has the sufficient amount of liability insurance covering injury to residents and guest. Physical Plant & Environment Safety: The facility is located in a residential neighborhood, consists of three (3) buildings with fifty-six (56) resident apartments. The facility has six (6) administrative offices, a reception area/lobby, beauty salon, wellness center, three (3) libraries, coffee/reading room, hospitality room, dining room, kitchen, mail room, communication room, activity /game room/painting/card making room, general store, housekeeping storage room, computer lab, nurses station, bingo room, exam room, staff lounge, and recovery room. There are multiple storage closets/rooms and an indoor/ outdoor activity area. The facility has fifteen (15) public restrooms, four (4) residential laundry rooms and a maintenance laundry room. Resident rooms consist of a bedroom, living room, dining area, kitchen, bathroom and walk-in closet. Bathrooms are clean and operable with grab bars and non-skid surface mats/strips. Hot water temperature was in a range of 109.5 to 129.9 degrees Fahrenheit which is not within range of 105.0 -120.0 degrees F. Adequate linen and personal hygiene supplies are in stock. (Continued on 809C) Staffing: There appears to be sufficient staffing at the facility. Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Admission Agreements and Physicians reports. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visiting hours are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: There are sufficient food supplies of 2-day perishable and 7 day non perishable food. The food is properly stored in the refrigerator to avoid cross contamination. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed 5 residents' medication, and most medication is administered according to doctor’s orders. Most all the over-the-counter medications did not have labels, and the aspirin was being shared with other residents in the community. and one resident’s was prescribed medication for 5 consecutive days and there is no documentation that was provided as ordered. Disaster Preparedness: The facility has an Emergency Disaster Plan but requires updating. Residents with Special Health Needs: There are no residents with special health needs at facility. Deficiencies cited and technical advisory provided. Exit interview conducted with Maria Vasquez and copy of report, 809D and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 3, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced Case Management Visit to follow up on a Special Incident Report (SIR) faxed to the Department on 4/11/25. LPA met with Vincent Gonzaga and explained the reason for the visit. The Department received an SIR dated 4/11/2025 indicating the following: On 4/10/25 R1 was hospitalized after experiencing an unwitnessed fall, this fall caused resident to sustain a hematoma to the forehead, left wrist, friction burns and fracture. LPA obtained copies of the following documents: R1's FACE Sheet, Appraisal Needs & Services Plan/IPP, Physician's Report, Medication List, and discharge paperwork from hospitalization dated 4/10/25. LPA toured R1's bedroom and activity room. No concerns, obstructions, or anything out of the ordinary was witnessed No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided to Administrator Vincent Gonzaga.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Anabel Mejia, Executive Assistant who assisted with the visit. The facility was licensed to serve one hundred & twelve (112) non-ambulatory residents, ages 60 and above. The facility had an approved five (5) hospice waivers. Administrator certificate was current with expiration date on 09/12/25. Annual fees were current. During the visit, Care Tool, physical plant, staff/residents interviews, file reviews, medication review, food supply review were conducted. The facility locates at a residential neighborhood, consists of three (3) buildings with fifty-six (56) resident apartments. The facility has six (6) administrative offices, a reception area/lobby, beauty salon, wellness center, three (3) libraries, coffee/reading room, hospitality room, dining room, kitchen, mail room, communication room, activity /game room/painting/card making room, general store, housekeeping storage room, computer lab, nurses station, bingo room, exam room, staff lounge, and recovery room. There are multiple storage closets/rooms and an indoor/ outdoor activity area. The facility has fifteen (15) public restrooms, four (4) residential laundry rooms and a maintenance laundry room. Resident rooms consists of a bedroom, living room, dining area, kitchen, bathroom and walk-in closet. Bathrooms are clean and operable with grab bars and non-skid surface mats/strips. Hot water temperature is in a range of 110.7 to 115.5 degrees Fahrenheit. Adequate linen and personal hygiene supplies are in stock. Sufficient supply of perishable and nonperishable foods were observed. (-continued in LIC 809 C-) Smoke / carbon monoxide detectors are operable and monitored by a fire alarm company. Elevators and signal system are operable which are available for residents' use. No bodily of water are observed in the facility. Swimming pool at the yard, pond at patio and jacuzzi at the first floor are empty with no water. They are locked, inaccessible to residents and surrounded with a 6-ft high fence. Medications are centrally, stored and locked and records are current. Fire/ Emergency drill conducted on April 2024 (every quarter). All mandated documents and signages are posted in common areas. The outdoor activity area is free of visible hazards and debris. An exit conference was conducted. A copy of LIC 809s were provided.the state’s words, verbatim · CDSS document, May 20, 2024