The Sequoias-Portola Valley

Type of visit: Case Management - Annual Continuation

On 11/21/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to continue the 1-year required Annual Inspection. LPA Calandra was greeted by Pam Marron, Director of Residential Services and explained the purpose of the visit. Amanda Martinez, Nurse Manager arrived later during the visit. LPA toured the physical plant. This facility has 30 buildings on the campus(2 of which are memory care and Assisted Living). The facility has a bowling green, spa/pool, putting green, Health Center, Dining room, Skilled Nursing Facility(not licensed by the Department), and Library. LPA inspected random rooms in Memory Care(The Gardens) and Assisted Living(The Lodge). All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed. All bathrooms inspected had slip resistant flooring and grab bars in the showers. Hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged and last inspected on 4/7/2025. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. All sharp objects, soap, poisons and medications were observed to be locked and in-accessible to persons in care. LPA received the following documents: Current LIC 500, Administrators Certificates, Emergency Operations Plan A review of Centrally Stored Medications 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 cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy provided.the state’s words, verbatim · CDSS document, Nov 21, 2025

Type of visit: Required - 1 Year

On 11/20/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility, to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Suzanne Wasley-Fairley, Executive Director and Amanda Martinez, Nurse Manager explained the purpose of the visit. LPA reviewed 6 staff files and 5 resident files. All were observed to be complete. LPA collected the following documents during the visit: Current LIC 500(Personnel Summary Report), Liability Insurance and Administrator Certificates for S1, S2, and S3. During record review, LPA observed that S1 did not have TB results. A Type A citation was provided for this citation. Deficiency is cited under the California Code of Regulations(CCR), Title 22. Failure to correct the Deficiency by the Proof of Correction(POC) due date may result in Civil Penalties. This Annual will be completed at a later date. An exit interview was conducted. This report was reviewed with facility representatives and a copy provided.the state’s words, verbatim · CDSS document, Nov 20, 2025

Type of visit: Case Management - Incident

On 5/1/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a case management visit follow up on an incident reported to the Department on 4/24/2025 regarding a resident who slipped and fell in their room and injured themselves. LPA Calandra was greeted by David Nelson, Clinic Manager and explained the purpose of visit. Through document review and interview, LPA learned that R1 who lives in independent living fell on 4/17/2025 and injured themselves. R1 contacted a family member who contacted the facility to inform them of the fall and staff responded promptly. Community Care Licensing Division(CCLD)/California Department of Social Services(DSS) does not provide oversight into the independent living portion of the facility. During the visit LPA reviewed and obtained copies of the following documents: - R1's physician report -R1's Appraisal of Needs and Services No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with David Nelson, Clinic Manager and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, May 1, 2025

Type of visit: Case Management - Incident

On 3/7/2025, Licensing Program Analysts(LPAs) John Calandra and Yi Sam Jian, arrived at the facility to conduct a Case Management visit in regards to a self-reported incident report received by the Department on 2/25/2025, regarding a resident who sustained multiple fractures. LPAs were greeted by David Nelson, Director of Clinical Services. LPAs received copies of the following documents: - Care notes for R1 - LIC 602: Physician's Report for R1 - Service Plan for R1 - Admissions Agreement No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with David Nelson, Director of Clinical Services and a copy of the report provided.the state’s words, verbatim · CDSS document, Mar 7, 2025

Type of visit: Required - 1 Year

On 11/25/2024, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Clinic Manager David Nelson, Linda West and Gloria Heimlich. LPA explained the purpose of the visit. LPA toured the facility inside and outside including a random sample of resident rooms, common areas, and kitchen area. Kitchen is located in the independent living building. Food is delivered in assisted living and memory care building. LPA observed residents engaged in different activities. Hot water temperatures were tested at 106 degF. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Facility has sprinkler system. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair. Bathrooms are equipped with grab bars and non-skid floors. There is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Eight resident records and eight staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete. Facility accepts hospice residents and are in compliance with the required waiver requirements. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA requested the following documents: LIC500 Personnel Report & Liability Insurance. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Nov 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA entered through the main lobby, met with front desk staff, and explained the purpose of the visit. Front desk staff contacted security to escort LPA to the Lodge and the Gardens area of the facility. LPA then met with lead nurse, which contacted Administrator April Thompson. April directed LPA to contact Sue Fairley, Executive Director (ED). ED Fairley appointed Nursing Staff Carmen and Flora to carry out the visit. The current census is 300 for the entire community. For the Assisted Living and Memory Care areas, the census is currently 40. LPA Valerio and facility staff toured The Gardens and The Lodge to ensure compliance with Title 22 regulations. LPA observed The Gardens. Exit doors were equipped with working alarm systems and required a lock code to exit. LPA observed toxins, cleaning supplies, sharps, and medications locked away and inaccessible to residents in care. Resident bedrooms were observed to be fully furnished. Bathrooms were observed to be clean, sanitary, and have necessary grab bars and hygiene supplies. Hot water temperature was measured to deliver hot water at 112.3*F, which is within the regulatory range of 105-120*F. LPA observed the Activity Director carrying out activities with residents. No health or safety concerns observed for The Gardens. LPA observed The Lodge side of the facility. Common areas, resident bedrooms, dinning area, medication room, and staff offices were observed. LPA observed residents in their bedrooms, sitting in common areas, walking out to the community, and eating lunch. Hot water temperature was measured at 113.0*F. No health or safety concerns observed for The Lodge. Fire pull alarm system, fire extinguishers, carbon monoxide detector, and fire detectors were observed to be in working condition for both areas of the facility. Continues on LIC 809 - C... Page 1 of 2 Continued from LIC 809 LPA reviewed 4 resident files. 4 out of 4 resident files were observed to be out of compliance. A copy of the LIC 811 was provided to staff for ED Sue Fairley for review. All staff on shift were observed to be fingerprinted and cleared. LPA Valerio spoke to Administrator April Thompson via cell phone. Administrator April informed LPA Valerio of an Administrator Change. LPA to inform San Bruno Regional Office LPA Jaime Vado and LPM Cara Smith. LPA Valerio requested the following annual documentation be sent to the San Bruno Regional Office: LIC 500 - Personnel Report LIC 308 - Designation of Facility Responsibility LIC 402 Surety Bond (if applicable) Qualifications of Administrator for ED Sue Fairly LIC 200 - Change of Administrator Application LIC 610E - Emergency Disaster Plan Copy of Liability Insurance Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiences were observed and are being cited today on the attached LIC 809 - D page. Appeal rights were provided. An exit interview was held, and a copy of the report was provided to Nursing staff Flora and Carmen.the state’s words, verbatim · CDSS document, Dec 16, 2023

Allegation investigated: Facility is not accepting resident back after discharge from a skilled nursing unit

On this day Licensing Program Analysts (LPA) Jaime Vado and John Calandra conducted an unannounced complaint investigation visit to deliver the findings regarding the allegation received. LPA met with Resident Services Director Pam Marron and explained the purpose of today's visit. During the course of the investigation interviews were conducted with the faciilty, the resident, the complainant, and other outside agencies. Interdepartmental agencies also assisted in the investigation in order to reach a finding. The resident was seeking placement back into an independent living unit. Per facility assessments and policy he is not able to return to independent living due to ambulatory status. The resident has been in the facility's SNF for several months. The facility has not complied with the transfer process required by health and safety code as outlined. The facility has not followed the transfer process as indicated in health and safety code. Per the records reviewed and recommendations provided the resident should be discharged from the facility SNF and transferred to assisted living to meet his/her needs. The allegation is substantiated. Based on LPA interviews, items, and letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D. Report is reviewed with Pam Marron Substantiatedthe state’s words, verbatim · CDSS document, Oct 6, 2023 · control 14-AS-20230316122510

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1788(a)(10)(A)-(C) · Plan of correction due date: May 26, 2023

Provisions of Contract - (a) A continuing care contract shall contain all of the following: (10) The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized: (A) A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence: (i) The resident is nonambulatory. The definition of "nonambulatory," as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary. (ii) The resident develops a physical or mental condition that is detrimental to or endangers the health, safety, or well-being of the resident or another person. (iii) The resident's condition or needs require the resident's transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be appropriately provided in the living unit. (iv) The resident's condition or needs require the resident's transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care. (B) Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements: (i) Involve the resident and the resident's responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the resident's or responsible person's request, family members, or the resident's physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident. An assessment tool or tools, including scoring and evaluating criteria, shall be used in the determination of the appropriateness of the transfer. The provider shall make copies of the completed assessment to share with the resident or the resident's responsible person. (ii) Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the resident's responsible person, and, upon the resident's or responsible person's request, family members, and the resident's health care professionals, to explain the reasons for transfer. (iii) Notify the resident and the resident's responsible person of the reasons for the transfer in writing. 51 (iv) Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process. (v) The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the resident's urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer. (vi) The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the resident's right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the department's Continuing Care Contracts Branch. (vii) The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma. (viii) For disputed transfer decisions, the provider shall provide documentation of the resident’s medical reports, other documents showing the resident’s current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria set out in subparagraph (A) are met. The provider shall make copies of the completed report to share with the resident’s responsible person. (C) The resident has the right to review the transfer decision at a subsequent care conference that shall include the resident, the resident's responsible person, and, upon the resident's or responsible person's request, family members, the resident's physician or other appropriate health care professional, and members of the provider's interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the resident's responsible person, or the provider. This health and safety code requirement has not been met as evidenced by: Facility did not follow the rules as outlined in HSC 1788(a)(10)(A)-(C) regarding resident trasfers.the state’s words, verbatim · CDSS document, Oct 6, 2023

Plan of correction: Facility shall ensure to follow the items outlined under CCRC Provisions of Contract regarding resident transfers. Review and proof of understanding is to be recieved by the Department.