<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601063
Report Date: 10/31/2024
Date Signed: 10/31/2024 01:53:33 PM

Document Has Been Signed on 10/31/2024 01:53 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
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: 6CENSUS: 2DATE:
10/31/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Stephanine Gaspar, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 31, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:40 PM to conduct a Plan of Correction (POC) visit and deliver the POC clearance letter in regards to the Annual 1-year required inspection completed on October 16, 2024. LPA Calandra was greeted by Stephanine Gaspar, Administrator and explained the purpose of the visit.

No deficiencies 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 along with the POC clearance letter was left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: 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)
Page: 1 of 1