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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 09/25/2024
Date Signed: 09/25/2024 04:05:25 PM


Document Has Been Signed on 09/25/2024 04:05 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:
09/25/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ricardo Aban, Executive Director TIME COMPLETED:
04:15 PM
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On September 25, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the unannounced 1-year required Annual Inspection. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit.

LPA Calandra reviewed 6 resident files. All were observed to be complete.

A review of the facility first aid kit showed that it had all the required components: a current edition of the first aid manual approved by the American Red Cross, sterile first aid dressing, bandages, scissors, tweezers.

LPAs also reviewed Personal and Incidental (P&I) monies kept at the facility. All P&I money kept at the facility matches the facility records.

No deficiencies were cited during today's visit.

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: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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