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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002288
Report Date: 02/04/2022
Date Signed: 02/04/2022 11:55:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PACHECO-VILLAROSA, TERESAFACILITY NUMBER:
414002288
ADMINISTRATOR:PACHECO-VILLAROSA, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 952-3432
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:14CENSUS: 6DATE:
02/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Teresa Pacheco-Villarosa, Erika EspinosaTIME COMPLETED:
11:55 AM
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
Licensing Program Analyst (LPA) Andrea Medlin met with facility representative and helper for this required annual licensing visit. Purpose of visit explained. Days and hours of operation: Monday-Friday 7:30AM-5:00PM. There are 6 children present during the visit; 3 infants and 3 preschool aged. Licensee states she, husband, two adult children and one minor child reside in the home; criminal record clearance is on file for all adults. Licensee reminded once a person turns 18 years of age and living here, criminal record clearance is required. Physical plant toured to inspect for health and safety hazards in the licensed areas. Outdoor space inspected for health and safety hazards; outdoor play area is completely fenced. The home has a fully charged fire extinguisher that meets the minimum requirements, smoke detectors, and a carbon monoxide (CO) detector. A complete first aid kit is available. Detergents, cleaning compounds, medications, and other items which could pose a danger to children is stored inaccessible to children. The daycare area has adequate heating and ventilation for safety and comfort. Per Licensee, there are no firearms or weapons in the home. No spas, swimming pools, hot tubs, fish ponds, or similar bodies of water are present. Variety of age appropriate toys and materials is observed in the daycare. Licensee provides all meals and snacks for children. All the required licensing forms are posted in the daycare. Children's files reviewed. In the children's files reviewed, all have complete records. Licensee has the required staff immunizations: measels (MMR) and pertussis (Tdap). Licensee has current Pediatric First Aid and CPR certification (exp 2/20/2023) and verification of the mandated child abuse reporter training as compliant with AB1207. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

(Continued on next page 809-C)
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PACHECO-VILLAROSA, TERESA
FACILITY NUMBER: 414002288
VISIT DATE: 02/04/2022
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
26
27
28
29
30
31
32
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2