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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881606
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:36:24 PM

Document Has Been Signed on 03/11/2025 03:36 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PASATIEMPO RESIDENTIAL CAREFACILITY NUMBER:
331881606
ADMINISTRATOR/
DIRECTOR:		CAMPOS, NERRENPHILIPPFACILITY TYPE:
735
ADDRESS:9937 PASATIEMPO PLTELEPHONE:
(714) 271-7290
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 4CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee- Janice CamposTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 03/11/25, Licensing Program Analyst (LPA) Debbie Palacios conducted an announced visit to the pending facility to conduct a pre-licensing inspection. LPA met with Applicants Janice and Nerren philipp Campos. Fire clearance has been granted for four (4) ambulatory clients and the facility will serve adults ages 18 through 59.

LPA conducted of a tour of the facility’s interior and exterior. LPA did not observe any clients residing in the home or evidence to suggest the home is currently occupied. The facility is made up of a one-story home with four (4) client bedrooms, one (1) staff bedroom, two (2) client bathrooms, one (1) staff bathroom, kitchen, living/family room, laundry room and garage. LPA did not observe bodies of water on the premises. The physical plant is in good repair. Indoor and outdoor passageways are free of obstruction. An outdoor shaded seating area is available for future clients. LPA observed one (1) charged fire extinguisher mounted in the kitchen wall. LPA tested the smoke alarms and carbon monoxide detectors and found them to be operational.

Client bedrooms had the required bedding, furniture, closet storage, and functional lighting. Additional linen and towels are available for future clients. LPA toured the kitchen and observed that food was stored in a safe and healthful manner. LPA observed that medications will be in a locked in the kitchen cabinet; staff and client files will be stored in a locked kitchen cabinet. Sharps and knifes are in a locked kitchen drawer.

LPA toured the bathrooms and observed bathrooms to be in safe and sanitary conditions. The hot water temperature in the client bathrooms measured at 108-degrees Fahrenheit. LPA observed that the cleaning solutions and detergents are stored in a locked closet in the hallway.

Living/family room has a working television and adequate seating in common areas. Fireplace in the living room has an appropriate barrier. The facility has a central heating and air conditioning system installed with a central panel located in the hallway to control entire house.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PASATIEMPO RESIDENTIAL CARE
FACILITY NUMBER: 331881606
VISIT DATE: 03/11/2025
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LPA toured the kitchen and observed that the facility had a 7-day supply of nonperishable food items. Emergency food, water and essentials are stored in the pantry area.

Emergency disaster plans, personal rights, and complaint procedures were posted throughout the facility . LPA observed a complete first aid kit, manual and PPE supplies.

During today’s visit, LPA did not observe any issues or concerns. On 03/11/25, Applicants Janice and Nerren Philipp completed the COMP III and final approval of licensure will be granted by the Centralized Application Bureau analyst.



An exit interview was conducted where a copy of this report was discussed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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