<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601140
Report Date: 10/18/2024
Date Signed: 10/21/2024 04:15:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241015090138
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
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Ricardo AbanTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Facility has bed bugs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced visit to deliver a copy of amended LIC9099 and LIC9099D report from 10/18/24 and issue an immediate $500.00 civil penalty for facility violating CCR 87468.1 Personal Rights of Residents in All Facilities. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

The Department assesses a civil penalty for a Zero Tolerance Violation (ZTV) for a violation of a licensing requirement that falls under one of the following categories: Violation that resulted in the injury or illness of an individual in care. The facility was found to be in violation of this section as facility was found to be unsafe and unhealthy due to R1 being bitten by bed bugs as indicated by medical discharge notes in the hospital ER on 10/12/2024. This is an immediate health and safety hazard to residents in care.

On October 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

Regarding the allegation, facility has bed bugs, it was reported that the facility has bed bugs. It is further alleged that residents complained to several staff regarding this issue as they have been enduring repeated incidents for 7 months of getting bitten several times by the bed bugs. Although staff members were aware of this, it had not been addressed resulting in at least one resident (R1) being transported to the hospital on 10/12/2024 where he was treated in the emergency room. During the investigation, LPA interviewed staff, resident, reviewed documents, and interviewed third party exterminating company. According to administrator interviewed, the bed bug issue at the facility has been going on since March of 2024 and the facility has had third party vendor, Western Exterminator Company coming into the facility every month to eradicate specific rooms at the facility that have bed bugs based on the inspection conducted by Western Exterminators. In addition, according to the administrator, the facility has not been fully treated by Western Exterminator Company and plans on scheduling a treatment plan which includes phases to eradicate the entire facility. According to the third-party exterminating company, it was indicated that the facility has a monthly agreement with the exterminators for rodents and insects which is under the general pest control agreement between the facility and Western Exterminator Company. (Cont. to 9099C).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Komal Charitra
COMPLAINT CONTROL NUMBER: 14-AS-20241015090138

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: DATE:
10/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Ricardo AbanTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Residents are not gettting medications as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit.

Regarding the allegation, R1 is not getting medication as prescribed, according to reporting party, (R1) was prescribed hydroxyzine when discharged from the hospital on 10/12/24.

During the investigation, LPA reviewed medications, observed medication administration record, physician’s medication order, interviewed staff, administrator, and R1. This specific medication, hydroxyzine, the medication label states: “take one tablet by mouth 4 times daily as needed.” Since the label uses the words, “as needed,” this is considered a PRN medication. During the record review and medication log review (MAR), LPA determined staff have given R1 the medication once at night on 10/17/24 and once in the morning on 10/18/24. LPA interviewed R1 and requests the medication four (4) times a day. Since this medication could be taken as needed as directed on the label, it is subject to the need and request of R1. LPA interviews with staff, S1 and S2, indicated that they deny R1 has requested this medication four (4) times a day. Due to conflicting information from each side, it is unknown whether R1 got his medication as prescribed since it can be subjective with the language of “as needed” on the prescription label.

Continue to 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
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.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 14-AS-20241015090138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/18/2024
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
Based on what R1 requests, staff deny that R1 has requested this medication be given this frequent, it is our (4) times a day, it cannot be determined if there is a violation due to conflicting statements.
 
Based on the Department's investigation, it was determined there was a lack of sufficient evidence to support or deny the allegation. Based on this information, the findings of this allegation is unsubstantiated.
 
This report was reviewed with Administrator, Ricardo Aban, and a copy is provided. A copy of this report must be made available for public review upon request.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
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
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 14-AS-20241015090138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
87303(a)
1
2
3
4
5
6
7
87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee/Administrator shall submit a plan in writing on how to ensure bed bugs are being eradicating throughout the entire facility. Plan shall include, company name, how often exterminators will come, where the exterminators with eradicate. Plan shall also include informing CCL regarding all services moving forward to ensure facility is in compliance with CCR 87303(a).
8
9
10
11
12
13
14
Based on obtained relevant records including: incident reports indicating bed bug issues (dated from March 2024 – current); medical documentation of R1 discharge notes that indicate R1 had bites due to bed bugs, and facility invoices for exterminator services. This resulted in a resident (R1) going to the hospital ER on 10/12/2024 with doctors determining the bites were caused by bed bugs. This is an immediate health and safety hazard to residents in care.
8
9
10
11
12
13
14
Type A
10/22/2024
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee/administrator shall submit a plan in writing on how to ensure the bed bugs at the facility will be eradicated. Plan shall include notifying CCL with eradication process, invoices from exterminators, how often the exterminators will be coming in.
8
9
10
11
12
13
14
Based on interviews conducted and records obtained: R1 was transported to the hospital ER on 10/12/2024 where doctors determined he had been bitten by bed bugs at the facility. This is an immediate health and safety hazard to residents in care.

8
9
10
11
12
13
14
An immediate civil penalty for a zero tolerance violation in regard to a violation of personal rights of the California Code of Regulations Title 22 is hereby assessed for $500.. Subsequent violations will result in additional civil penalties.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
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
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 14-AS-20241015090138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/18/2024
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
In addition, it was stated that the bed bugs service is under a different agreement which needs to be requested from the other party. According to the administrator and invoices provided by the facility as a contract between Western Exterminator Company and Hopkins Manor was not provided, it was noted that the bed bug monthly inspection initially began in March of 2024 when a housekeeper observed bed bugs, however all invoices show that specific rooms were only treated.  LPA reviewed records and conducted interviews with R1 and staff (S1) and (S2).  Upon review of the hospital discharge papers, it was indicated that the cause of R1's bites was the result of bed bugs.  Based on all the above information, along with the hospital discharge note where a medical professional determined the bites were the result of bed bugs, this allegation is found to be true.
 
Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8, Article 5. Failure to correct said deficiencies may result in additional civil penalties.
 
This report was reviewed with Administrator, Ricardo Aban, and a copy is provided. A copy of this report must be made available for public review upon request.
 
Appeal rights given and explained during the visit.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
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
LIC9099 (FAS) - (06/04)
Page: 5 of 5