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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 07/21/2021
Date Signed: 07/22/2021 09:17:57 AM

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:ABAN, RICARDOFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(650) 368-5656
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: DATE:
07/21/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Travis WyckoffTIME COMPLETED:
10:35 AM
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On 07/21/2021 at 1100, Regional Manager (RM) Vivien Helbling, Licensing Program Manager (LPM) Julio Montes, and Licensing Program Analyst (LPA) Jaime Vado conducted an announced tele-meeting to discuss the stipulation order and waiver with Co Licensee Travis Wyckoff and his attorney Joel Goldman via Microsoft Teams video conference. The purpose of today's meeting is to review and discuss the waiver and order that was issued to Travis Wyckoff.

The stipulation waiver and order is reviewed with Travis in the presence of his attorney Joel Goldman via video conference.

This report is reviewed with Travis at the conclusion of this meeting.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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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