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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004909
Report Date: 02/07/2025
Date Signed: 02/07/2025 04:19:13 PM

Document Has Been Signed on 02/07/2025 04:19 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PACHECO, TINA M.FACILITY NUMBER:
384004909
ADMINISTRATOR/
DIRECTOR:		TINA PACHECOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 781-5739
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94158
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:18 PM
MET WITH:Tina PachecoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 2/7/2025, at approximately 2.55pm, Licensing Program Analyst (LPA) conducted the unannounced case management visit to follow up the new child card license application. The applicant, Tina Pacheco granted LPA entry. The applicant informed LPA that she found another location for the new child daycare facility. Hence, the applicant told LPA that the applicant withdrew the application with immediate effect.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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