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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 10/04/2020
Date Signed: 10/04/2020 05:03:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:HOPKINS MANOR PACIFIC CORPORATIONFACILITY NUMBER:
415600927
ADMINISTRATOR:WYCKOFF, TRAVISFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(415) 806-4069
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 35DATE:
10/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Travis Wyckoff, AdministratorTIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Praveen Singh conducted a Case Management health and safety inspection with Administrator Travis Wyckoff, due to concerns regarding infection control and staffing.

During the inspection, LPA toured the facility on the second floor. LPA observed a sufficient supply of perishable and non-perishable foods. LPA made observations and obtained additional information from Administrator regarding the status of infection control, staffing, and residents.

No deficiencies cited during this inspection. Exit interview conducted with Assistant Administrator Alice Alejandrino via phone conference and a copy of the report emailed to Assistant Administrator.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Praveen SinghTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2020
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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