415601140-10-21-2024-14-AS-KCHA-DA9VUE-20241021164438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 415601140
Report Date: 10/21/2024
Date Signed: 10/21/2024 04:44:48 PM

Document Has Been Signed on 10/21/2024 04:44 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 MANOR		FACILITY NUMBER:	415601140
ADMINISTRATOR/ DIRECTOR:	RICARDO ABAN		FACILITY TYPE:	740
ADDRESS:	1235 HOPKINS AVE		TELEPHONE:	(510) 390-8078
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY: 88		CENSUS: 79	DATE:	10/21/2024
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Administrator, Ricardo Aban		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced plan of correction visit in response to a visit that was conducted on 10/18/2024. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

On October 18, 2024, LPA Charitra conducted a complaint visit and issued a deficiency for CCR 87303(a) Maintenance and Operation. The due date for this deficiency was 10/19/2024. In addition, LPA conducted an unannounced case management visit for CCR 87205(a) Accountability of Licensee Governing Body and 87405(h)(1) Administrator- Qualifications and Duties. The due date for these deficiencies were 10/19/2024.

87205 - Accountability of Licensee Governing Body – Regarding this POC you submitted, please provide clarification regarding the following: Since using the same exterminator as used previous, please explain how facility will eradicate bed bugs for entire facility. The administrator will provide detailed exterminator contract services being provided at facility with specifics in regard to: dates of services, how frequent, duration, areas covered, how residents are and will be affected, how will they be accommodated, how will residents and their families be notified? How will facility ensure the safety of residents during extermination services? What are the “bed bug detection tools being referenced to and in what manner being used for specifically?

87405 Administrator-Qualifications and Duties - Proof that the pest control company he hires is licensed, and perhaps a estimate or written outline from the exterminator on their letterhead what their plan is for treating bed bugs. Who is providing the staff training and following facility’s established bed bug management policy – what is the policy? What specifically are the staff going to be trained in and who is providing the training? When will the training be conducted? How often? Will it be logged and sent to licensing? Transparent communication with residents and their families; how will this be done? What method and how frequent? He talks about cost efficiency. What does that mean in terms of the pest control services? How will you be in compliance with health department guidelines and please specify what those are? What are the alternate accommodations being referred to for residents in the event that is needed?

87303 Maintenance and Operation - How often will CCL be notified and specifically state how you will ensure you will be in compliance with the regulation section – maintenance and operation. Provide a written estimate from an exterminator company that specifies the services covered; frequency of extermination services; if there will be a possibility that residents may have to relocate due to harmful toxics during fumigation, what and where does the administrator accommodate them; how often he will notify CCL, i.e. weekly, monthly, etc and for how long? Finally, how will you ensure compliance with this regulation? (Cont. to 809C)

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)

Page: 1 of 2

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
	VISIT DATE: 10/21/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Due to the citation 87303(a) Maintenance and Operation, not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected.

Due to the citation 87205(a) Accountability of Licensee Governing Body, not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected.

Due to the citation 87405(h)(1) Administrator- Qualifications and Duties not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected.

Report is reviewed with Administrator. A copy of the report is provided. A copy of the civil penalties is provided with appeal rights.

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

LIC809 (FAS) - (06/04)

Page: 2 of 2