415600927-1-28-2022-14-AS-KHOS-CCSKBZ-20220323074623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600927
Report Date: 01/28/2022
Date Signed: 01/28/2022 11:37:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2021 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210908122540

FACILITY NAME:	HOPKINS MANOR PACIFIC CORPORATION		FACILITY NUMBER:	415600927
ADMINISTRATOR:	ABAN, RICARDO		FACILITY TYPE:	740
ADDRESS:	1235 HOPKINS AVENUE		TELEPHONE:	(650) 368-5656
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	88	CENSUS: 30	DATE:	01/28/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ricardo Aban		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility did not follow doctors orders regarding modified diet

INVESTIGATION FINDINGS:

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On this day at 1100hrs, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint inspection to deliver findings on the above allegation. LPA met with administrator Ricardo Aban and explained purpose of todya's visit.

During the course of the investigation inerviews are conducted and documents are reviewed. it was found that the facility followed the discharge orders for R1 when transferred to the facility from the nursing home after being assessed. The facility followed the order of a minced diet from the nursing home but later found out that they were incorrect. The PCP of R1 ordered a pureed diet but the nursing home did not provide that updated order to the faciltiy. Upon discovery of this the faciltiy immediately changed the diet of R1 to a pureed diet. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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