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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 04/08/2022
Date Signed: 04/08/2022 12:36:17 PM


Document Has Been Signed on 04/08/2022 12:36 PM - It Cannot Be Edited

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: 32DATE:
04/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Ricardo AbanTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management investigation visit in response to the facility property being sold and a management company being put in place while a change of ownership application is being processed. LPA met with administrator Ricardo and administrator Martha during today's visit.

During today's visit LPA observed the facility. Upon entry LPA's temperature was taken and COVID screening questions were asked. LPA observed residents eating lunch. Administrators are aware that the facility has been sold and aware that a management company is being put in place as the facility transitions to a new owner. Administrator has received a copy of the management agreement from the current licensee. According to the administrator all facility operations are running as normal. Utilities and facility bills are being paid. There is no shortage of food supplies as they are still receiving deliveries. Staff are in place. LPA observed staff during today's visit providing care and supervision. Masking requirements by staff are observed as in place.

LPA discussed that the current licensee did not provide licensing with a notification of the sale of property until until the sale of the sale was finalized. Additionally the licensee did not provide the residents and families of the residents with a 60 day notice of the changes being made regarding the facility. LPA informed the administrator that the licensee is still responsible for the facility's license and obeying all regulations under Title 22 as the license is still active until the application for new ownership is finalized. All citations, penalties, and other licensing activities will still be directed to the current licensee.

LPA provided technical assistance with the administrator regarding the 60 day notification and needing that to be sent out to residents and families as soon as possible. Ideally today as the sale of the property has been finalized.

Report is reviewed with Ricardo.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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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