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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517432
Report Date: 07/20/2022
Date Signed: 07/20/2022 11:15:02 AM


Document Has Been Signed on 07/20/2022 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:UNIVERSITY HEIGHTS CHILDREN'S CENTERFACILITY NUMBER:
410517432
ADMINISTRATOR:GASTON, SHIRLEYFACILITY TYPE:
850
ADDRESS:2066 AVY AVENUETELEPHONE:
(650) 854-6993
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:31CENSUS: 0DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Director, Shirley GastonTIME COMPLETED:
11:20 AM
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On July 20th, 2022 at 9:25AM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with Director, Shirley Gaston and explained the purpose of the inspection.

Facility operates in Building A and C. Facility is currently in Summer Break and there are no children present at this facility. Fall Session will return back in session on September 6th, 2022. Facility also owns Building B, which is facility #410518206. Director agrees that facility will need to have an inspection done when facility is back open.

A notice of Site Visit was provided and must be posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Shirley Gaston.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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