415600927-5-24-2023-14-AS-KHOS-CSBNJ9-20230530102958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600927
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:31:46 PM

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
03/15/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230315092022

FACILITY NAME:	HOPKINS MANOR PACIFIC CORPORATION		FACILITY NUMBER:	415600927
ADMINISTRATOR:	WU, LULIN		FACILITY TYPE:	740
ADDRESS:	1235 HOPKINS AVENUE		TELEPHONE:	(650) 368-5656
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	88	CENSUS: 66	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Ricardo Aban		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff neglect resulting in resident sustaining injuries while in care.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jaime Vado condcuted an unannounced complaint investigation visit to deliver the findings regarding the above allegation. LPA met with administrator Ricardo Aban and explained the purpose of today's visit.

During the investigation LPA conducted interviews, reveiwed documents as well as photos of alleged injuries. LPA could not prove that the photos observed were in fact from the time the resident was residing in the facility. Interviews conducted with other outside agencies, and other persons could not prove that the injuries took place in the facility as well, as the time frame of when and where the photos were taken. 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.

Report is reveiwed with the administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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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