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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601063
Report Date: 10/31/2024
Date Signed: 10/31/2024 11:03:38 AM

Document Has Been Signed on 10/31/2024 11:03 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MISSION WOODSIDEFACILITY NUMBER:
415601063
ADMINISTRATOR/
DIRECTOR:		GASPAR, STEPHANINEFACILITY TYPE:
740
ADDRESS:2028 MARYLAND STREETTELEPHONE:
(650) 445-0510
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
10/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Stephanine Gaspar, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On October 31, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:00 AM to deliver Amended reports that were provided by LPA Calandra on October 16, 2024 in relation to the 2024 Annual 1-year required inspection. LPA Calandra was greeted by Stephanine Gaspar, Administrator and explained the purpose of the visit.

The following reports were amended: LIC 809, LIC 809C, LIC 809-D, and Civil Penalties Assessment form. During the visit, LPA Calandra amended the reports and provided the Administrator, Stephanine Gaspar, and the Licensee with a copy.

The facility surrendered the following reports to the Department: LIC 809, LIC 809C, LIC 809-D, and LIC 421BG (Civil Penalty Assessment form) received by the facility on October 16, 2024.

No deficiencies other than the one listed on the amended report were cited during today's visit.

An exit interview was conducted and this report was reviewed with Stephanine Gaspar, Administrator and a copy of the report left at the facility.
Andrea MedlinTELEPHONE: (650) 266-8811
John CalandraTELEPHONE: 650-266-8800
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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