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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 09/20/2024
Date Signed: 09/20/2024 04:09:39 PM


Document Has Been Signed on 09/20/2024 04:09 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:HOPKINS MANORFACILITY NUMBER:
415601140
ADMINISTRATOR:RICARDO ABANFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVETELEPHONE:
(510) 390-8078
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY:88CENSUS: 81DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ricardo Aban, Executive Director TIME COMPLETED:
04:15 PM
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On September 20, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:00 PM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit.

LPA Calandra toured the physical plant. This is a 3 story building with 54 bedrooms and 21 bathrooms, staff rooms, lounge, dining room, kitchen, front lobby, beauty salon, and medication room. All bedrooms were observed to have the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. Hot water temperature was measured within the required range of 105-120 degrees Fahrenheit. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged and last checked on February 26, 2024 The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired.

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

LPA Calandra reviewed 6 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(CSMR) kept at the facility.

No deficiencies were cited during today's visit. The Annual inspection will be completed at a later date.

An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024
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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