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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 12/10/2020
Date Signed: 01/04/2021 09:23:37 AM

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:ABAN, RICARDOFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(650) 368-5656
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: DATE:
12/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ricardo Aban, IPTIME COMPLETED:
10:45 AM
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On December 10, 2020, Licensing Program Manager (LPM) Liza King and DSS Nurse Consult Helen Shi conducted an unannounced case management visit via Microsoft Teams at 9:30am. The team met with Infection Preventionist Ricardo Aban, and Executive Director Martha Estalano.

The team toured the isolation area. At the exterior of the area was a PPE station included a plastic 3 drawer container as previously recommended by the Department. The ROs suggestions for improvements to the area include different size N95 masks and gloves, an inventory list on the exterior of the container and labeled drawers. The PCC recommended N95 fit testing of identified staff working the area. Additionally, proper signage for COVID area zone should be displayed, as should donning and doffing procedures. The team toured the hall leading to one isolation bedroom. The Departments recommendations include the proper Covid zone signage on the exterior of the room as well as a reminder to staff to enter with full PPE. On the interior of the door the RO recommended the reminder signage for resident and staff exiting the room. In the bathroom, soap and paper towels were observed, handwashing signage was present. Inside the room, the PCC recommended plastic bags to line a hamper and a hamper to be present.
Upon exiting the room the PCC inquired of the cleaning procedure inside the room, the LPM asked to view the cleaning solution, inquired what disinfecting solution is used and the SIT time, facility staff including the IP were unable to provide information. It is recommended that the IP review the facilities cleaning and disinfecting procedure and implement training of staff.
No deficiencies were observed during today’s call. Exit interview was conducted with Martha, Admin where LPM reviewed report via telephone. An electronic copy of the report was emailed to the facility to obtain a signature from the Administrator and emailed back to LPM to be filed.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
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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