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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601063
Report Date: 12/05/2023
Date Signed: 12/05/2023 12:16:35 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
06/26/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230626083229
FACILITY NAME:MISSION WOODSIDEFACILITY NUMBER:
415601063
ADMINISTRATOR:CONDE, GABRIEL V.FACILITY TYPE:
740
ADDRESS:2028 MARYLAND STREETTELEPHONE:
(650) 554-1000
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:6CENSUS: DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Stephanine GasparTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
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5
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8
9
- Staff did not provide medications as needed
- Staff did not communicate with authorized representative in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations above. LPA met with the administrator Stephanine Gaspar and explained the purpose of today's visit.

During the investigation LPA conducted interviews and reviewed documents from the facility. It is discovered that the facility did provide the medications per the prescription provided and through interviews and documentation observed. The medications were prescribed "as needed" and the facility followed as prescribed. In regards to communication with authorized representative, the person on file as was out of the country at the time, so communication to them was received at a delay on their end. The facility did communicate with the additional family members listed due to the authorized representative not being immediately available. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Report is reviewed with Stephanine Gaspar.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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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