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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 05/06/2022
Date Signed: 05/06/2022 01:39:55 PM


Document Has Been Signed on 05/06/2022 01:39 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: 35DATE:
05/06/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Ricardo AbanTIME COMPLETED:
02:00 PM
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On this day at 1240 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - Legal/Non-compliance inspection. LPA met with administrator Ricardo Aban.

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 27, 29, 30, 33 and 50 are observed. Room 30 is now a resident room. PPE supplies have been moved to room 20 and are in place. Room 26 incontinence supplies are observed to be in place. Next to room 30 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. Food supplies are also observed and are in place.

No deficiencies are cited today.

This report is reviewed with administrator Ricardo.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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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