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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380500593
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:46:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
10/29/2024 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 14-AS-20241029161809
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: DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Glen Goddard, Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Residents are not provided care with activities of daily living
Residents are not provided social interaction and participation in activities
Resident are not provided appropriate foods that meet dietary restrictions
Resident's incontinence care needs or not being met
INVESTIGATION FINDINGS:
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On 1/28/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Glen Goddard. LPA toured the facility, interviewed staff and residents, gathered facility records and made observations during the course of the investigation.

Complaint alleges residents are not provided care with activities of daily living. Upon multiple tours of the facility, LPA did not observe any signs of resident needs not being met. Residents in the assisted living and memory care portions of the facility appeared to be in a comfortable manner. LPA conducted interviews with residents (R1, R2, R3) all of which found facility level of care and assistance with daily living to be adequate. Residents also stated that they utilize pendants to call staff in emergencies with no reports of concern. Lastly, upon interviews with staff (S1, S2, S4, & S5) LPA received contradicting information towards the allegation with no indication of other caregiver staff not meeting resident needs.

Complaint alleges residents are not provided social interaction and participation in activities. Upon multiple tours of the facility, LPA observed residents engaged in various group and individual activities. LPA also conducted interview with Director of Life Enrichment (S3) who provided LPA with monthly activity calendars specialized for both assisted living and memory care. In addition, LPA observed staff encouraging residents to participate in integrated events that are offered to all residents. During inspection LPA observed staff escorting memory care residents to an animal/pet education event with staff and residents actively engaging.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 14-AS-20241029161809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 01/28/2025
NARRATIVE
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Complaint alleges resident are not provided appropriate foods that meet dietary restrictions. Upon tour of the facility, LPA found that the facility kitchen is equipped with a sufficient amount of food supplies, meeting nutritional value. LPA found that the facility provides several entree options each meal with additional daily items and snacks to choose from. Residents also mark or write requests on meal preferences. Kitchen staff have record of resident dietary restrictions with notation of restrictions labeled on the menu for each individuals' diet. Upon interviews with residents (R1, R2, R3), LPA received inconsistent information regarding food taste but was found that the facility provides 3 meals a day with a variety of nutritious food options. Upon interviews with staff (S4, S5), LPA received contradicting information towards the allegation with no indication that resident dietary needs are not met.

Complaint alleges resident's incontinence care needs or not being met. Based upon multiple tours of the facility assisted living and memory care, LPA found resident living areas to be clean with no signs of foul odors or residents left soiled. Interviews with residents (R1, R2, R3) indicated no concerns with staff providing toileting or hygiene needs. Upon interviews with staff (S2, S4, S5) LPA found that staff conduct routine room checks for incontinence and general care. Staff (S1, S2, S4 & S5) also stated that there no concerns of caregiver staff not meeting incontinence care requirements.

A finding that the complaint allegations, residents are not provided care with activities of daily living,
residents are not provided social interaction and participation in activities, resident are not provided appropriate foods that meet dietary restrictions and resident's incontinence care needs or not being met are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2