Masonic Home for Adults

On 9/1/2021 starting at 10:20am, Licensing Program Analyst (LPA) L. Francisco arrived announced to conduct a Case Management for the newly constructed Pavilion Building and met with Chief Clinical Officer, Joseph Pritchard and Executive Director, Soledad Martinez. The Pavilion Building is a two story building of which memory care is located in the first floor and assisted living is in the second floor. The building has a total of 28 units with a total capacity of 28. LPA L. Fontanilla was provided a copy of the Temporary Certificate of Occupancy (TCO) from City of Union City by Chief Clinical Officer and was also advised by Fire Inspector that facility is ready for inspection. LPA L. Francisco, Pritchard and Martinez inspected a total of 4 units, 2 on each floor. LPA observed bathrooms in each units were equipped with grab bars and non-skid shower base. Both Memory Care and Assisted Living were equipped with Life line emergency response buttons. Assisted living units were equipped with sink, refrigerator and microwave, and Memory care units were equipped with a sink. LPA observed delayed egresses are installed in memory care floor. Smoke detectors were tested and observed in working condition as well as integrated with the Fire Department. LPA was informed assisted living residents are tentatively scheduled to move in mid-September and end of September for memory care residents. Based on observation and recommendation from the Fire Inspector, LPA recommends that Pavillion building is ready to admit new residents once Certificate of Occupancy has been approved by the city. Exit interview conducted and a copy of report provided.

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.

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.

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.

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.

**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.

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.

On this day at around 9:15 am, Licensing Program Analysts (LPAs) Lizette Francisco and Luisa Fontanilla conducted an unannounced 1 Year Required Inspection. Upon arrival at the Pavilion Building, LPAs met with Licensed Nurse (LVN) Princess Chan and explained the reason of the visit. Soledad Martinez, Executive Director arrived at around 9:45 am. The Pavilion is a two storey building with 2 residents in Memory Care Unit on the first level and 8 Assisted Living residents on the upper level. LPAs toured facility with LVN including but not limited to bedrooms, bathrooms, kitchen and common areas. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ bathrooms was measured at 105.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid shower pan. Fire extinguishers were last purchased on 3/11/2022. First aid kit was observed to be complete. LPAs reviewed five resident records and 5 staff records. All staff are fingerprint cleared and have current first aid training. At around 4:30 pm, LPAs inspected the Wollenberg Building which has 8 Memory Care residents. Five residents and 5 staff were interviewed. LPAs reviewed 5 staff and 5 resident files. LPAs will return to continue inspection at a later time.

On 1/18/2023 starting at 11:20 AM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct a Case Management visit to follow-up on facility renovation in the Wollenberg building. Fire clearance was approved on 12/20/2022. LPA met with Executive Director, Soledad Martinez and explained the purpose of the visit. Fire clearance was approved all non-ambulatory residents. The building currently has no residents occupying the floor. During the Case Management visit, LPA toured facility including but not limited to dining room area, activity room, medication room, laundry room, and random resident rooms. LPA observed smoke detector, carbon monoxide detector and sprinklers throughout facility. Hot water temperature was maintained at 109.7 degrees F. Fire extinguisher was last serviced on 1/10/2023. The expected move-in date for residents is scheduled at end of January/early February. Administrator agrees to submit an invoice for water leak repair in APT 512 by 1/30/2023. Exit interview conducted and a copy of this report provided.

On 7/28/2022 at 3:30PM , Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a case management visit. LPA met with Executive Director Soledad Martinez, and explained the reason for the visit. LPA went to the facility to deliver an immediate exclusion letter and verified that S1 was no longer working at the facility. LPA delivered letter to Soledad Martinez. LPA confirmed that S1 was not at the facility. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

On 4/27/2022 at 12:40PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Soledad Martinez, Executive Director and explained the purpose of the visit. Upon entry, LPA's temperature was checked. LPA observed screening station that contained hand sanitizer, masks, automatic temperature checker and COVID signage. LPA toured facility including but not limited to common areas, shared bathrooms, apartments, and kitchen. LPA observed cough etiquette, physical distancing signs, and hand sanitizer dispenser in the common areas. All hand washing stations were equipped with soap, paper towel and hand washing signs. Hot water temperature in the shared bathroom was measured at 116.6 degrees Fahrenheit. Fire extinguishers was last serviced on 1/4/2022. During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food, and paper supplies are sufficient. No deficiencies were observed during visit. Exit interview conducted and a copy of this report provided.

On 3/23/2022 at 2:20 PM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct a Case Management visit to follow-up on facility renovation. Fire clearance was approved on 3/15/2022. LPAs met with Executive Director, Soledad Martinez and explained the purpose of the visit. Fire clearance was approved all non-ambulatory residents. During the Case Management visit, LPAs toured facility including but not limited to multiple activity rooms, medication room, laundry room, random resident rooms, and dining area. LPA observed smoke and carbon monoxide detector and sprinklers throughout facility. Fire extinguisher was last serviced on 1/20/2022. No issues during inspection. Exit interview conducted and a copy of this report provided.