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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:51:57 PM


Document Has Been Signed on 02/15/2023 12:51 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



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: 60DATE:
02/15/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ricardo AbanTIME COMPLETED:
01:00 PM
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On this day, 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 16, 17, 42, and 51 are observed. Room 17 is vacant in case for COVID quarantine reasons. PPE supplies are located on every floor and observed as in place. Main PPE storage area is observed in a locked basement area. Incontinence supplies are observed to be in place in basement area storage with PPE. Cleaning cart is observed as locked in a closet in a room on the ground floor. 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 was observed with residents present and eating meals during lunch hour. Dining room is clean condition and no obstructions are observed. LPA observed all staff wearing masks. COVID signs and posters are in place through out the facility. 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: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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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