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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 07/21/2023
Date Signed: 07/21/2023 02:40:21 PM


Document Has Been Signed on 07/21/2023 02:40 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 MANORFACILITY NUMBER:
415601140
ADMINISTRATOR:WU, LULINFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVETELEPHONE:
(510) 390-8078
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 71DATE:
07/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Ricardo AbanTIME COMPLETED:
02:45 PM
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Pre-Licensing Inspection visit. LPA met with administrator, Ricardo Aban an explained the purpose of the visit. This facility is currently licensed and has residents in place.

LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA observed the indoor and the outdoor passageways are free of obstruction. This is a single level facility. The facility has 52 resident rooms of which 4 are private rooms. All bedrooms were equipped with required furniture. LPA observed several resident rooms at random and all are observed with required furniture and lighting. bathrooms to be odor-free and in good repair. Non-skid mats were observed to be present in three bathrooms in resident rooms. Water temperatures throughout the facility was measured at 116F in resident bathrooms on each floor. On the ground floor there are staff rooms and private dining area for staff adjacent to the food storage room.

Living room and dining room are observed to be comfortable, spacious and free from any tripping hazards. Temperature through out the facility is comfortable and is maintained throughout the facility. Facility lighting is sufficient for comfort and safety. LPA toured the kitchen area and observed it to be clean and in good repair. Facility refrigerator temperatures are within regulatory standards. Temperatures are checked and signed off by staff. These records are posted on the refrigerators observed. Medication room is observed to be locked on the third floor. Medication carts used to hold medications are double locked. First aid kit is observed as in place. Dry goods/emergency food supplies are stored on the ground floor. Chemicals and toxins were observed to be in a janitorial closet with a cleaning cart also on the ground floor away from the food supplies. It is observed as locked and inaccessible to residents. Laundry room is observed in good repair with multiple washing machines and dryers in place. Extra linens are observed to be present in a third floor linen closet. A random sampling of resident and staff records is conducted. MAR is observed as current.

All fire prevention systems such as sprinklers, smoke detectors, carbon monoxide detectors, Ansul system, fire extinguishers, and fire control panel have been inspected as in in place. Fire panel is observed as inspected on 08/08/2022 expiring on 08/2027.

Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued. LPA is recommending licensure of the facility.

Component III is conducted and report is reviewed with Ricardo. A copy of report is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
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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