Facility Evaluation Report

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.

An exit interview is conducted, and a copy of the report is provided.