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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600927
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:58:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
09/16/2022 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20220916114354
FACILITY NAME:HOPKINS MANOR PACIFIC CORPORATIONFACILITY NUMBER:
415600927
ADMINISTRATOR:WU, LULINFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(650) 368-5656
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ricardo AbanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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-Resident(s) left unattended outside
-Staff yelling for no reason
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit. LPA me with administrator Ricardo Aban and explained the purpose of today's visit.

During today's visit LPA discussed the allegations received, reviewed and obtained copies of resident documents pertinent to the investigation, and made facility observations. It is discoverd that the staff person that is yelling, the yelling is not directed at any residents or staff. It is a loud speaking staff person and it is his way of communicating. LPA observed this staff and confirmed that the staff person does speak loudly even while outside. Although this does take palce, there is no violation found in regards to this.

Continued on next.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20220916114354
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HOPKINS MANOR PACIFIC CORPORATION
FACILITY NUMBER: 415600927
VISIT DATE: 09/22/2022
NARRATIVE
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Regarding the resident's being left attended outside, it is discoverd that a majority of the residents stayed outside was during the heat wave that took place approximately two weeks. The residents were outside in the parking lot area and patio area adjacent to the parking lot. The parking lot is gated. According interviews conducted the resident's were outside around 11pm 12am, 3am, and 6am. Per scheduling and administrator, there are three night staff on site during those hours. Although staff did not stay with the residents as they needed to also supervise residents inside, they regularly checked on the residents outside to ensure they are safe. Regarding a resident roaming outside the facility gates LPA could notconfirm at this time based on one party's word over the other. No reports of falls or injuries took place during the heat wave.

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. No citations issued. Report is reviewed with Ricardo.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2