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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201136
Report Date: 04/21/2022
Date Signed: 04/21/2022 04:45:59 PM

Document Has Been Signed on 04/21/2022 04:45 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PACALDO-YEE S CORPORATIONFACILITY NUMBER:
019201136
ADMINISTRATOR:TBDFACILITY TYPE:
740
ADDRESS:999 TORRANO AVETELEPHONE:
(650) 393-0265
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14CENSUS: 9DATE:
04/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Juliet Pacaldo and Tessa Cruz, ApplicantsTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) C. Lin and L. Fici conducted a face to face Component III presentation on 04/21/2022 starting at 3:45pm. LPAs met with applicants Juliet Pacaldo and Tessa Cruz respectively.

LPAs presented Component III power point and discussed the regulations embodied in the PowerPoint. LPAs observed the two participants gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted with applicants and a copy of the report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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