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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
415600927
Report Date:
10/06/2020
Date Signed:
10/07/2020 03:35:27 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
851 TRAEGER AVE., SUITE 360
SAN BRUNO
,
CA
94066
FACILITY NAME:
HOPKINS MANOR PACIFIC CORPORATION
FACILITY NUMBER:
415600927
ADMINISTRATOR:
WYCKOFF, TRAVIS
FACILITY TYPE:
740
ADDRESS:
1235 HOPKINS AVENUE
TELEPHONE:
(415) 806-4069
CITY:
REDWOOD CITY
STATE:
CA
ZIP CODE:
94062
CAPACITY:
88
CENSUS:
35
DATE:
10/06/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Travis Wyckoff
TIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit to drop off PPE to the facility. LPA met with the licensee Travis Wyckoff at the front of the facility.
LPA provided facility with PPE for facility use. Licensee discussed with LPA staffing plans and projected numbers going into the morning of 10/07/2020. LPA reminded licensee about the CHHS guidelines and required postings that LPA sent to licensee on 10/02/2020. Food supplies are in place according to licensee. Will contact CCLD if more PPE is needed.
No deficiencies cited during todays visit. Report discussed with licensee. A copy of this report will be sent to licensee via email.
SUPERVISOR'S NAME:
Julio Montes
TELEPHONE:
(650) 272-7906
LICENSING EVALUATOR NAME:
Jaime Vado
TELEPHONE:
(559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE:
10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/07/2020
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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