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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011440129
Report Date: 06/05/2026
Date Signed: 06/05/2026 02:23:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2026 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20260603090038
FACILITY NAME:MASONIC HOME FOR ADULTSFACILITY NUMBER:
011440129
ADMINISTRATOR:SOLEDAD MARTINEZFACILITY TYPE:
741
ADDRESS:34400 MISSION BLVD.TELEPHONE:
(510) 471-3434
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:242CENSUS: 208DATE:
06/05/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Soledad Martinez, Executive DirectorTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Lack of supervision resulting in financial abuse of resident
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20260603090038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MASONIC HOME FOR ADULTS
FACILITY NUMBER: 011440129
VISIT DATE: 06/05/2026
NARRATIVE
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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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2