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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601115
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:15:28 PM

Document Has Been Signed on 01/30/2025 03:15 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:GORDON MANORFACILITY NUMBER:
415601115
ADMINISTRATOR/
DIRECTOR:		GADDI, PORTIAFACILITY TYPE:
740
ADDRESS:1616 GORDON STREETTELEPHONE:
(650) 562-0555
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 82CENSUS: 71DATE:
01/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Portia Gaddi, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 1/30/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:45 AM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Portia Gaddi, Administrator and explained the purpose of the visit.

LPA toured the physical plant. This is a 1-story building with 54 bedrooms and 52 bathrooms, a living room, dining room, kitchen, and outdoor space/backyard. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. According to the Administrator, the fire alarms are directly connected to the Redwood City fire department. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit.

All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care.

LPA reviewed 7 resident records and 5 staff files. All were observed to be complete.

A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility.

LPA received the following records at the facility:
  • Current Liability insurance
  • Relias training transcripts
  • Emergency/Disaster drill documentation

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GORDON MANOR
FACILITY NUMBER: 415601115
VISIT DATE: 01/30/2025
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LPA requested the following documents be sent to the Department by 2/7/2025:
  • Current LIC 500

No deficiencies were cited during today's visit.

This report was reviewed with Portia Gaddi, Administrator and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC809 (FAS) - (06/04)
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