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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804287
Report Date: 03/06/2025
Date Signed: 03/06/2025 11:25:47 AM

Document Has Been Signed on 03/06/2025 11:25 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PASITOS RESIDENTIAL - ELISA'S HOMEFACILITY NUMBER:
486804287
ADMINISTRATOR/
DIRECTOR:
ELISEO, ALDRINFACILITY TYPE:
735
ADDRESS:300 MONO DRIVETELEPHONE:
(650) 483-8133
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Aldrin Eliseo and Erika DiazTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst Jill Nakagawa arrived announced to conduct a Prelicensing Inspection and met with Applicants Aldrin Eliseo and Erika Diaz. Aldrin Eliseo will be the Administrator of the facility.

LPA toured facility with applicants. Facility was a comfortable temperature, well lit and passageways were free from obstructions. There are no residents currently in care. There are five (5) bedrooms, two (2) bathrooms, a living room, dining room and kitchen with eating area and bar. There are two (2) sturdy ramps on the back side of the house providing easy access to and from the facility in an emergency. The garage is set up to be used by clients for activities and socializing. Facility has been cleared by the local fire department. Hot water temperature registered at 120.0 which is within acceptable range of 105 to 120 degrees F. Multiple cabinets in the kitchen have locks for medications and first aid supplies. Activity supplies were observed in a cabinet in the living room. Activities to be offered will include karaoke, stationary bike, arts and crafts, gardening. The backyard has a nice patio with outside seating and an umbrella for shade. Toxins are secured in a locked cabinet under the kitchen sink. Knives are secured in a locked kitchen drawer. Pots, pans, utensils, and kitchen supplies were adequate. Non-perishable food supplies were sufficient. Furniture items and linen supplies are available. Smoke detectors and carbon monoxide detector were tested and operational. Emergency information and telephone numbers were posted at facility. Fire extinguishers were located in kitchen and garage; fully charged. First aid supplies and flashlights were available. Required postings were observed.

Component III was reviewed with representatives. CCL Application Unit will be notified of inspection and facility will be considered for Licensure.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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