The Sequoias

In the surveyor’s words

From the most serious findings on record at The Sequoias, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812May 24, 2024

  Based on observation, interview, and record review, the facility failed to ensure safe and sanitary conditions were met for food storage in the kitchen when there was a garlic oil container beyond its use-by date in the refrigerator. This failure had the potential to put residents at risk for foodborne illnesses. Findings: During a concurrent observation and interview on [DATE] at 11:05 AM with Director of Dining Services (DoDS), and Executive Chef (EC) in the kitchen, there was one peeled garlic oil container in the refrigerator with a use-by date of [DATE]. DoDS stated, the garlic oil was expired when asked. He acknowledged that it should have been tossed out. EC also acknowledged it was expired. […]

• No harm, potential for more than minimal, patternF812Aug 7, 2025

  Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety, when a carton of orange juice and 4 cartons of apple juice and a paper cup wrapped in plastic, inside the refrigerator in the pantry, has no expiration date, has no use by date, cup has no label. This failure has the potential to put residents at risk for foodborne illnesses.During a concurrent observation and interview on 8/4/25 at 10:30 AM, with Registered Dietitian (RD), in the refrigerator in the pantry, found one orange juice carton, and four apple juice cartons, with no expiration date and no use by date, and one paper cup wrapped in plastic no label. […]

• No harm, potential for more than minimal, patternF655Dec 30, 2021

  Based on interview and record review the facility failed to provide residents with the written summary of the Baseline Care Plan (BCP, Baseline Care Plan is developed and implemented for each resident that includes the instructions needed to provide effective and person centered care of the resident that meet professional standard of quality care and must be developed within 48 hours of a resident's admission) for seven (7) residents out of 12 sampled residents, Residents 4, 16, 18, 6, 13, 14, 75. Failure to provide written summary of the BCP to the residents had the potential to compromise person-centered care to each resident, and to safeguard against adverse events that are most likely to occur right after admission. Findings: 1. […]

• No harm, potential for more than minimal, patternF658Dec 30, 2021

  Based on observation, interview, and record review, the facility failed to provide care and treatment according to standards of clinical practice for two of 12 sampled residents (Resident 4 and Resident 21) when: 1. The Omeprazole (a medication used to treat frequent heartburn and stomach ulcers) was not administered according to current physician's orders [MEDICAL RECORD OR PHYSICIAN ORDER] . 2. The facility's procedure on management of indwelling catheter and closed drainage system was not implemented for Resident 21. This failure had the potential to cause cross contamination of infection that may jeopardize the health and safety of Resident 21. Findings: 1. […]

• No harm, potential for more than minimal, patternF814Dec 30, 2021

  Based on observation and interview, the facility failed to ensure the garbage are contained and a dumpster are covered. This facility's failure has the potential to attract pest to the area. Findings: During an observation and concurrent interview on 12/29/21, at 2:36 PM, the Environmental Manager acknowledged two garbage containers, and one dumspter were uncovered. There was a plastic bag of garbage lying on the ground. by one of the open garbage container. Environmental Manager stated that he has to remind the housekeepers. During an interview on 12/29/21, the Director of Nursing stated, We do not have a policy for garbage disposal or pest control. During an interview on 12/20/21, at 3:45 PM, the Administrator stated, We do not have a policy for garbage disposal. […]