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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 01/28/2022
Date Signed: 01/28/2022 11:38:27 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: 30DATE:
01/28/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ricardo AbanTIME COMPLETED:
11:30 AM
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On 01/28/2021 at 1000 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - Legal/Non-compliance inspection. LPA met with administrator Ricardo Aban and Martha Estolano. LPA explained purpose of inspection to both Martha and Travis.

During today's inspection visit LPA made observations within the facility with Ricardo. 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 34, 40, 43, and 50 are observed. The rooms observed are in good condition. Cleaning solutions are stored and locked on ground floor. An adjacent storage room is observed were cleaning cart and additional cleaning supplies are locked. PPE storage is also on the ground floor and is observed as in place. Room 40 is being cleaned during today's inspection and cleaning cart is observed with staff nearby. 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 are observed with residents present and eating meals. Group activities are on hold at this time due to COVID present in the facility but on this day the facility no longer has any COVID residents. Dining rooms are in clean condition and no obstructions are observed. LPA observed all staff wearing masks. COVID signs, social distancing signs, and posters are in place through out the facility. Isolation area is observed is in place and is being cleaned. This area is licensed to receive non-COVID residents as well as long as no COVID resident are in place. Fresh food supply and non-perishable food supply is inspected and is observed as in place.

No deficiencies are cited today.

This report is reviewed with Ricardo Aban.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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