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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600927
Report Date: 10/13/2020
Date Signed: 09/05/2023 10:56:48 AM


Document Has Been Signed on 09/05/2023 10:56 AM - 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:WYCKOFF, TRAVISFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVENUETELEPHONE:
(415) 806-4069
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 34DATE:
10/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Maria Cantora TIME COMPLETED:
06:00 PM
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On 10/13/2020 at 1730hrs Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management tele-inspection. LPA met with temporary manager Maria Cantora.

LPA discussed with Maria concerns regarding residents with injuries, pressure sores, or other pre existing health conditions that may have gone unreported to licensing office. LPA explained the history and timeline regarding COVID and the facility. She discussed with LPA some of the conditions of some of the residents that may have unreported items prior to the onset of COVID19 at the facility. She says she will work on the linelist and update the LPA with those residents and their information.


Report discussed with the temporary manager about the process in which the facility will receive a copy of this report and the e-signing of this document. A copy of this report will be sent to the licensee and temporary manager.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2020
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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