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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 10/18/2024
Date Signed: 10/18/2024 05:28:40 PM


Document Has Been Signed on 10/18/2024 05:28 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: 78DATE:
10/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Ricardo AbanTIME COMPLETED:
05:45 PM
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On October 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit in relation to complaint #: 14-AS-20241015090138. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

During the complaint investigation conducted on 10/18/24, the facility has had bed bugs as an ongoing problem since March 7, 2024. LPA reviewed and obtained documentation related to exterminator services conducted by Western Exterminator Company. Based on review of this, it appears these services have been ongoing for ten (10) years with monthly provider services. However, upon further review of this, this extermination services contract with facility indicates, the services are specific for rodents and insects. Nowhere in these extermination services is listed as bed bugs being addressed. Based on this, it proves there was a lack of follow through on the part of the facility administrator for accountability, failing to ensure the best interest and welfare of their residents, and failing to establish policies regarding operation within licensing regulations. In addition, the administrator also failed to take responsibility and administer the facility operation in accordance with licensing regulations, resulting in an unsafe environment for residents.

The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8. Failure to correct said deficiencies may result in additional civil penalties.

This report was reviewed with facility representative, and a copy of this report must be made available for public review upon request. A copy of this report is provided to the facility.

Appeal rights discussed and provided to facility representative during the visit.

SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 629-4305
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024
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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Document Has Been Signed on 10/18/2024 05:28 PM - It Cannot Be Edited

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: HOPKINS MANOR
FACILITY NUMBER: 415601140

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/19/2024
Section Cited
CCR
87205(a)

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87205 Accountability of Licensee Governing Body: (a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves.

This regulation is not met as evidenced by:
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Licensee/administrator to submit a plan in writing to describe how ensure compliance with CCR 87205(a).
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Based on information obtained, the facility having ongoing bed bug problems since March of 2024. The licensee did not exercise general supervision of the facility that resulted in ongoing issues of bed bugs wherein R1 was directly harmed and bitten by bed bugs. This resulted in R1 being transported to the hospital emergency room where a medical professional determined R1 had been bitten by bed bugs. This is an immediate health and safety hazard to residents in care.
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Type A
10/19/2024
Section Cited
CCR87405(h)(1)

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87405 Administrator - Qualifications and Duties: (h) The administrator shall have the responsibility to: (1) Administer the facility in accordance with these regulations and established policy, program and budget.

This regulation is not met as evidenced by:
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Licensee/administrator to submit a plan in writing to describe how administrator will comply with CCR 87405 Administrator Qualifications and Duties.
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Based on LPAs review of records and interviews regarding the Administrator failing to take responsibility and administer facility operation in accordance with licensing regulations. It is noted that facility has exterminator monthly services, however upon review of this, the services do not address extermination of bed bugs for the entire facility. This resulted in at least one resident (R1) being harmed and bitten by bed bugs. This is an immediate health and safety hazard to residents in car. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 629-4305
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024
LIC809 (FAS) - (06/04)
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