Routine inspection·April 15, 2025

At approximately 9:10 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Leonida Lacap. Masonic Guest Home II 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 two (2) residents. Upon arrival, LPA was informed that there were six (6) residents in care and two (2) staff members on-site. At approximately 9:25 AM, 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 9:30 AM, 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 9/10/2024. Fire Department inspected and cleared the facility in March, 2024. 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. Regulations' stipulate that the facility should be conducting fire and emergency drills quarterly. LPA observed that the last disaster drill was conducted on 12/1/2024. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Continued on 809-C ...Continued from 809 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. At approximately 10:10 AM, LPA reviewed five (5) resident files. Four (4) of five (5) resident files were found to be missing various documentation. Resident one's (R1) file was observed to be missing signed personal rights and preplacement appraisal documents. Resident two's (R2) file was observed to be missing personal rights and an annual medical assessment. Resident three's (R3) file was observed to be missing an annual medical assessment. Resident 4's (R4) file was observed to not have reappraisals completed from 2021 to 2023. These deficiencies will be sighted. LPA reviewed three (3) staff files. Two (2) of three (3) staff files were found with all required documentation including First Aid and CPR certification and proper training documentation. Staff member S1's file was observed to be missing the LIC 503 Medical assessment and Tuberculosis (TB) test and current 1st Aid and CPR certification. These deficiencies 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 10/14/2025. LPA requested the following documents be submitted to Community Care Licensing by 5/15/2025: LIC 500 Personnel Report 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-809Ds, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Lacap. Signature on form confirms receipt of documents.