415601140-1-29-2025-14-AS-AMEN-DDKPVK-20250204103916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601140
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:14:10 PM

Unsubstantiated

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
07/17/2024 and conducted by Evaluator John Calandra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240717093038

FACILITY NAME:	HOPKINS MANOR		FACILITY NUMBER:	415601140
ADMINISTRATOR:	RICARDO ABAN		FACILITY TYPE:	740
ADDRESS:	1235 HOPKINS AVE		TELEPHONE:	(510) 390-8078
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	88	CENSUS: 85	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Ricardo Aban, Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff did not prevent physical altercation(s) between residents which resulted in multiple injuries and hospitalization.
Facility staff punched resident in the face.
Facility staff do not dispense medications as prescribed.
Facility staff do not ensure the facility is free of hazards.
There is no night supervision staff on duty who stays awake.

INVESTIGATION FINDINGS:

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On 1/29/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 12:35 PM to deliver conclusionary findings for a complaint received by the Department on 7/16/2024. LPA met with Ricardo Aban, Executive Director and explained the purpose of the visit.

Regarding the allegation that facility staff did not prevent physical altercation(s) between residents which resulted in multiple injuries and hospitalization. The reporting party stated that R1 had sustained significant injuries including head trauma and a fracture. Information regarding time and date could not be obtained. RP also stated that R1 had obtained scars, but no documentation of scars could be provided. In addition, the inspector could not verify scarring based on observation. Based on interviews and document review, no evidence of head trauma or fracture was found.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20240717093038

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: 01/29/2025

NARRATIVE

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Complaint alleges that facility staff punched resident in the face. According to the Reporting Party, R1 was attacked by staff on two separate occasions. Based on interviews and document, R1 was admitted to the hospital but no documentation of R1’s injuries could be obtained. Through the course of the investigation, it was learned that R1 had assaulted staff on one of these occasions. Additional details could not be obtained on either attack such as date, time, place, assailant, etc. Furthermore, it is unknown whether R1 was the assailant or victim as no injuries were sustained.

Regarding the allegation, that facility staff do not dispense medications as prescribed, LPA reviewed documents and interviewed staff. According to the reporting party, the Facility did not get a resident’s medication on time and the resident had to wait 30 days. Reporting party states that one resident’s medication consistently went missing.Record reviews showed that medications were given on time and that no medications were missing for R1.

Regarding the allegation, that facility staff do not ensure the facility is free of hazards, LPA toured the physical plant. According to the reporting party, the facility has electrical outlets with open wires, a ramp outside that has holes, and a bathroom has a towel rack where a grab bar should be installed. Based on observations, none of these hazards are present.

Complaint alleges that there is no night supervision staff on duty that stays awake. Per Reporting Party, staff are not awake and asleep in the Executive Director’s office. Based on document review, the facility does have awake night supervision staff. Through interviews, LPA learned that the Administrator’s office is locked in the evenings and night supervision staff are unable to access it.

The Agency has investigated the above allegations. The allegations are UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.

SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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