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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600593
Report Date: 01/21/2026
Date Signed: 01/21/2026 02:34:55 PM

Unfounded


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
01/13/2026 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260113095218
FACILITY NAME:PENINSULA VILLAGEFACILITY NUMBER:
415600593
ADMINISTRATOR:RAMOS, ANDREWFACILITY TYPE:
740
ADDRESS:108 E. HILLSDALE BLVD.TELEPHONE:
(650) 345-1357
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:6CENSUS: 6DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administartor - Terry IlliastronTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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- Licensee did not ensure facility was free from black mold
INVESTIGATION FINDINGS:
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On 01/21/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unnannounced complaint inspection visit in regards to the allegation received allegation. LPA met with administrator Terry Illastron and explained the purpose of today's visit.

During today's inspection LPA conducted interviews and made observations within the facility. LPA inspected facility bathrooms and did not observe black mold. As part of the investigation, LPA spoke with San Mateo County Code Enforcement as well who made an unannounced inspection visit to the facility on 01/13/2026 and made their own observations. Per their observatons made, there were no signs of what they would consider as black mold. Code Enforcement observed only dust and other signs of regular treatable mold that would not be considered as black mold. The mold described was minor due to condensation on a bathroom ceiling caused by shower steam, that is not considered to be black mold and is cleanable not neading any major renovation or construction to clean as it is wipeable. According to to Code Enforcement, black mold is in the drywall or wood that spreads through out that would need to be removed and replaced via contractors. Per San Mateo Code Enforcement's observations and LPA observations, no black mold was present in resident bathrooms or the facility. This allegation is unfounded.

This agency has investigated the complaint alleging, "Licensee did not ensure facility was free from black mold". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

This report is reveiwed with Terry and a copy is provided on this day.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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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