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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200347
Report Date: 01/07/2025
Date Signed: 01/07/2025 01:21:54 PM

Document Has Been Signed on 01/07/2025 01:21 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:MISSION HOPE DAY PROGRAM, FREMONTFACILITY NUMBER:
019200347
ADMINISTRATOR/
DIRECTOR:		BETCHIE TERRADOFACILITY TYPE:
775
ADDRESS:43154 OSGOOD ROADTELEPHONE:
(510) 226-1600
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 45CENSUS: 25DATE:
01/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Ferdylin Amsden, Program Director TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 01/07/2025 at 12:45 PM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit regarding a self reported incident report abuse that occured on 01/03/2025. LPAs met with Program Director, Ferdylin Amsden, and explained the purpose of the visit.

LPAs obtained the following documents such as the Employee's Termination Notice, Incident Report, and SOC341.

LPAs interviewed the Administrator who stated that S1 was terminated today, 01/07/2025.

LPAs were unable to interview C1. C1 refused to respond to LPAs.

The incident was reported to Fremont Police Department and has completed investigation. The investigation was referred District Attorney's Office for review.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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