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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 10/07/2020
Date Signed: 10/14/2020 03:42:45 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 CORPORATIONFACILITY NUMBER:
415600927
ADMINISTRATOR:WYCKOFF, TRAVISFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(415) 806-4069
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 35DATE:
10/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Travis WyckoffTIME COMPLETED:
12:30 PM
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On October 7, 2020, LPAs Michael Garcia and Murial Han conducted a case management inspection to conduct health and safety check on residents. LPAs met with Travis Wyckoff, administrator.

According to Administrator, staff and residents were tested for COVID-19 last week. Six (6) residents tested negative and five (5) are awaiting results. Five (5) staff tested negative and one (1) awaiting results. The facility’s COVID-19 mitigation plan was discussed. Administrator is coordinating with San Mateo County Public Health and Community Care Licensing in monitoring the COVID-19 cases at the facility.

In addition, LPAs drop off Personal Protective Equipment (PPE) supplies of N915 masks, gloves, gowns and hand sanitizers during the visit.

An electronic copy of the report was emailed to Travis for signature.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Michael GarciaTELEPHONE: (650) 380-4608
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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