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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004685
Report Date: 02/17/2023
Date Signed: 02/17/2023 09:42:16 AM

Document Has Been Signed on 02/17/2023 09:42 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PACHECO, TINA M.FACILITY NUMBER:
384004685
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Tina PachecoTIME COMPLETED:
09:55 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
On February 17, 2023 at 8:26 AM, Licensing Program Analyst (LPA) Cowan met with applicant, Tina Pacheco, and conducted an announced Pre-Licensing inspection. This inspection is due to a Relocation Application received in the Regional Office on 2/10/23. Licensee has a current license (#384004371) also in the city of San Francisco.

Applicant is present alone in the home this day. Applicant lives in a one bedroom, one bathroom apartment alone. Day-care areas: Living room, dining area, kitchen, bedroom, hallway, and bathroom. Off Limit areas: Hallway closet. The applicant states that this is their primary residence where they live full time. The day-care operates 8:30 AM to 5:30 PM, Monday through Friday.
At 8:30 AM, LPA toured and inspection the house for health and safety hazards. There is a fully charged 2A10BC fire extinguisher, working cellular phone, and building installed smoke and carbon monoxide detectors in the home. Applicant has children’s furniture and toys in the home. There is no fireplace in the home. Per licensee, there was no guns in the home. Licensee, she will provide meals and snack for children. Applicant’s CPR expires 2/19/24. Applicant has current Mandated Reporter Training Certification expiring 2/17/25. Applicant has all required postings posted. Discipline is mainly redirection. Applicant does not have any pets.

*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.


*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Licensee was given information regarding ‘Safe Sleep’ practices.
>>> See next page
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PACHECO, TINA M.
FACILITY NUMBER: 384004685
VISIT DATE: 02/17/2023
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
Page 2
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.

Licensee has IMS policy on file at Regional Office.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

Exit interview conducted and report was reviewed with the licensee.

Licensee must complete the following items prior the approval:
1. Cover corners of the three lower levels of book shelf.
2. Cover corners of entrance bench.
3. Lock hallway closet.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2