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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500593
Report Date: 05/31/2024
Date Signed: 05/31/2024 01:54:05 PM

Document Has Been Signed on 05/31/2024 01:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SEQUOIAS SAN FRANCISCO (THE)FACILITY NUMBER:
380500593
ADMINISTRATOR/
DIRECTOR:		GLEN GODDARDFACILITY TYPE:
741
ADDRESS:1400 GEARY BLVDTELEPHONE:
(415) 922-9700
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY: 400CENSUS: 272DATE:
05/31/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:06 AM
MET WITH:Steve Martinez, HR Manager and Casey Hobbs, Director of Nursing Services TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On May 31, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:06 AM to complete the Annual Inspection. LPA Calandra was greeted by Casey Hobbs, Director of Nursing Services and explained the purpose of the visit. Steve Martinez, Human Resources(HR) Manager joined later during the visit.

LPA Calandra reviewed 5 staff files. All were observed to be complete.

LPA Calandra also interviewed 5 staff.

A review of Centrally stored medications in the Memory Care unit indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility.

No deficiencies were cited during today's visit.

This report was reviewed with Steve Martinez, HR Manager and a copy of the report left at the facility.


SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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