415600927-8-29-2023-14-AS-KHOS-CVSH7Y-20230918055732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600927
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:40:49 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
08/07/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230807122959

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: 72	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Ricardo Aban		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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- Resident fell due to staff neglect
- Staff are not responding to residents call buttons in a timely manner

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations received. LPA met with administrator Ricardo Aban and explained the purpose of today's visit.

During the investigation LPA conducted interviews and made observations. According to information gathered a resident may have fallen but not due to neglect of the facility. The resident in question has a history of falls and if a fall did happen that was unwitnessed it is not neglect of the facility in not having staff in place. The faciilty does have an unwitnessed fall protocol. If the resident fell on their own and if it went unreported then staff would not have known in order to address the fall. Facility is taking precautions and extra measures to aid the resident in preventing falls. In regards to the call button not being answered in a timely manner, LPA could not prove or disprove this allegation as it appears based on observations and interviews that staff do respond to the call button requests. Response times vary due to overall resident needs through out the facility. These allegations are 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 reviewed with Ricardo.

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: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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