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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 10/21/2024
Date Signed: 10/21/2024 04:08:14 PM

Document Has Been Signed on 10/21/2024 04:08 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/
DIRECTOR:		RICARDO ABANFACILITY TYPE:
740
ADDRESS:1235 HOPKINS AVETELEPHONE:
(510) 390-8078
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94062
CAPACITY: 88CENSUS: 79DATE:
10/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Administrator, Ricardo Aban TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to deliver a copy of amended report from 10/18/24 and issue and immediate $500.00 civil penalty in relation to complaint control: 14-AS-20241015090138 for facility violating California Code of Regulation (CCR) 87468.1 Personal Rights of Residents in All Facilities. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

Report is reviewed with Administrator and a copy is provided. A copy of the civil penalty and appeal rights is also provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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