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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 08/11/2021
Date Signed: 08/11/2021 02:12:17 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:ABAN, RICARDOFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(650) 368-5656
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 26DATE:
08/11/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Travis WyckoffTIME COMPLETED:
02:30 PM
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On 08/11/2021 at 1045 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - Legal/Non-compliance inspection. LPA met with administrator Martha Estolano initially then met with Travis Wyckoff at 1055. LPA explained purpose of inspection to both Martha and Travis.

During today's inspection visit LPA made observations within the facility with both Martha and Travis. This is a three floor facility. Residents reside within the three floors but most on the second floor. LPA observed resident rooms at random on each floor. Rooms 15, 27, 30, 32, 35, and 42 are observed. Room 30 is on the ground level and is where cleaning solutions are stored. An adjacent storage room is observed were cleaning cart and additional cleaning supplies are locked. LPA did not observe any cleaning solutions unlocked during today's inspection. Linen closet is observed on the third floor as plentifully stocked. Within all resident rooms observed LPA did not see any soiled linens or odorous smells indicating such. in resident rooms observed each contained trash bins with tight fitting lids and pedals to operate these bins. These trash bins are not observed as full or needing the bags replaced. Dining rooms were observed with residents present and eating meals. Dining rooms are in clean condition and no obstructions are observed. LPA observed all staff wearing masks. COVID signs and posters are in place through out the facility. Isolation area is observed is in place. This area is licensed to receive non COVID residents as well as long as no COVID resident are in place. As of today's inspection the facility does not have any COVID positive residents or staff.

No deficiencies are cited today.

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

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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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