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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415201160
Report Date: 01/26/2024
Date Signed: 01/26/2024 11:36:13 AM


Document Has Been Signed on 01/26/2024 11:36 AM - 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:HUDSON MANORFACILITY NUMBER:
415201160
ADMINISTRATOR:WENDY MANIAMFACILITY TYPE:
740
ADDRESS:278 HUDSON STREETTELEPHONE:
(650) 298-8888
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:6CENSUS: 5DATE:
01/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rolly TabagoTIME COMPLETED:
11:30 AM
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On 01/26/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with caregiver Rolly Tabago and explained the purpose of today's visit. Around 1045am the licensee Wendy Maniam arrived at the facility.

LPA was allowed entry into the facility. This is a one level facility. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored in the kitchen locked in a drawer adjacent to the sink. Cleaning solutions are also locked below the sink. Perishable and non-perishable food items are observed as in place. LPA observed the medications as in place and locked in a cabinet. The first aid kit observed as complete with required items. LPA observed that the facility contains several fire extinguishers that are placed through out the facility last being inspected 08/17/2023, smoke detector/carbon monoxide detectors are observed in place, and central heating system. PPE and additional food supplies are observed as in place in the garage. Laundry area is also observed as fully operational located in the garage. Additional food supplies are in the garage in a stand up freezer and refrigerator. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 118F. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Cleaning supplies are observed locked below kitchen sink and in the garage. COVID PPE and resident supplies are in place. Administrator certificate expires 01/04/2025. Per today's visit the facility will be vacant of resident as of 01/31/2024. LPA received closure notice December 2023.

This annual inspection be continued at a later date.

Report is reviewed with licensee Wendy Maniam.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
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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