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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380500593
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:26:57 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/22/2023 and conducted by Evaluator Audrey Jeung
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230522130802
FACILITY NAME:SEQUOIAS SAN FRANCISCO (THE)FACILITY NUMBER:
380500593
ADMINISTRATOR:GLEN GODDARDFACILITY TYPE:
741
ADDRESS:1400 GEARY BLVDTELEPHONE:
(415) 922-9700
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:400CENSUS: 279DATE:
03/14/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Glen GoddardTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Resident sustained serious injuries from a fall

- Resident not receiving nutritious meals from facility which made resident malnourished and weak
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Based on investigation conducted by LPA Jeung of the Community Care Licensing Division of the CA Department of Social Services, these allegations are determined to be unfounded. This means that the allegations could not have happened and/or are without a reasonable basis.

Client #1 resided independently in room 6K from 11/29/08 until 3/9/23, when she fell in her room. Client sustained serious injuries, but client attributed the fall to her house slippers. Resident was discharged from hospital on 3/15/23 to skilled nursing unit of facility--licensed by CA Dept. of Health Services. She has relocated permanently to the skilled nursing unit.

According to executive director, there is one kitchen that provides meals for all residents in assisted living, memory care, and skilled nursing. A full-time registered dietician--qualified by formal training or experience--is responsible for the operation of the food service for the entire building. LPA obtained copies of the certification and job description.

In January 2023--prior to March 2023 fall--client's primary care physician documented that client chronically complains about food, doctors, etc., and is allergic to garlic and legumes. Client told LPA that she is allergic to berries, as well. Following the fall, SNF staff documented that "resident was noted to have extensive food preferences," and she complained about food quality.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Audrey Jeung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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