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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 380500593
Report Date: 01/15/2026
Date Signed: 01/15/2026 12:51:00 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
12/11/2025 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251211155543
FACILITY NAME:SEQUOIAS SAN FRANCISCO (THE)FACILITY NUMBER:
380500593
ADMINISTRATOR:TERENCE TUMBALEFACILITY TYPE:
741
ADDRESS:1400 GEARY BLVDTELEPHONE:
(415) 922-9700
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:400CENSUS: 352DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Roxann KingTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not provide proper care to a resident
INVESTIGATION FINDINGS:
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On January 15, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the complaint investigation. LPA met with the Memory Care Director, Roxann King and explained the purpose of today's visit.

Regarding allegation of- staff did not provide proper care to a resident, the reporting party stated that staff #1 (S1) observed resident #1(R1) was sleeping in a wet bed full of urine or with briefs above R1's knees because night shift staff #2 (S2) did not clean R1.

As part of the investigation, LPA interviewed the director and facility staff members and conducted observation.

LPA interviewed the director who stated that S1 is no longer working at the facility and the director acknowledged that a few months ago, S1 reported a resident was not being cleaned by the CNA (S2) on the previous shift (night shift). Subequently, the director went to observed R1 and witnessed the situation with R1 that was not as reported by S1 but the director provided one-to-one meeting/education to S2 regarding the incident.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 14-AS-20251211155543
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: 01/15/2026
NARRATIVE
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LPA interviewed S2 who remembered the meeting/education with the director, however, denied leaving resident in a wet bed full of urine or with briefs above their knees. S2 stated that he/she always made sure the residents are cleaned and S2 also stated that it is common for a resident to urinate right after they were cleaned and changed.

LPA interviewed 4 other staff members and all of them reported that they have not witnessed residents sleeping in a wet bed full of urine or with briefs above the resident's knees from the previous shifts.

During LPA's visit on 12/18/2025, LPA observed R1 appeared to be well groomed, cleaned and pleasant. LPA attempted to interview R1 but R1 did not remember staff not providing proper care.

Based on record review, observation and interviews during the investigation, this allegation is deemed to be unsubstantiated as the director stated that she went to observed R1 after S1's reporting and she did not observed R1 was in the condition that was described by S1. In addition, the director stated that re- education was provided to S2 who denied the allegation. Furthermore, 4 out of 4 staff members stated that they have not witnessed residents sleeping in a bed full of urine or with the briefs above their knees.

Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
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