Facility Evaluation Report

Pasatiempo Residential Care, Moreno Valley02/21/2025Licence 331881606

Capacity4
Census0
Date signed02/21/2025 02:18:59 PM
The inspector’s account

COMP II Participants: Licensee Janice Jabonero and Administrator Nerren Philipp Campos

On 2/21/2025, applicant/administrator participated in COMP II. Identification of the

applicant and administrator was verified through interview questions based on photo ID

and other identifying personal information. During COMP II, applicant and administrator

confirmed that they have read and understand community care facility licensing laws

included in the Health and Safety Codes and the California Code of Regulations Title

22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction