197607861-1-7-2025-29-AS-ABAN-DCPRBF-20250107115240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607861
Report Date: 01/07/2025
Date Signed: 01/07/2025 11:54:06 AM

Document Has Been Signed on 01/07/2025 11:54 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DREAM HOME FOR SENIORS, LLC		FACILITY NUMBER:	197607861
ADMINISTRATOR/ DIRECTOR:	ZENAIDA & RICARDO VELASCO		FACILITY TYPE:	740
ADDRESS:	20743 CLARK STREET		TELEPHONE:	(818) 667-4111
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/07/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:50 AM
MET WITH:	Zenaida Velasco		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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	Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:51AM. The last annual visit was done on 02/26/2024. Administrator Zenaida Velasco opened the door at 10:53AM. Entrance interview conducted. Administrator reported to LPAsthat the facility does not have any residents at this time, that her family is living at the residence. No residents present. LPA toured the physical plant areas inside and outside, with Administrator at 10:54AM. BEDROOMS: There are four (4) bedrooms designated for resident use. Bedroom #2 and Bedroom #4 have a direct exit to the exterior. Each bedroom has adequate lighting. Bedroom #3 leads to a hallway, which allows for access to Bedroom #5 and Bedroom #6; however, those two rooms designated for staff. There is an exterior door that leads to Bedroom #5 and Bedroom #6. Staff are aware that once they have residents in Bedroom #3, staff would need to enter their rooms through the exterior door. Administrator stated that Bedroom #3 will most likely not be for resident use and plans to decrease capacity to five (5). RESTROOMS: There are two (2) bathrooms designated for resident use. There is a bathroom designated for staff use only. Bathrooms are in operating condition with grab bars. LPA observed one (1) restroom without a slip-resistant mat and Administrator stated they will purchase one. Hot water temperature was tested at 11:08AM and was 136.6 degrees F, which is above the required range. Administrator stated that family is currently living in the property and they prefer hot water, but the water temperature will be lowered before admitting residents and when family vacate. Continued on LIC 809-C

Kristin Heffernan	TELEPHONE: (818) 596-4493
Angela Barutyan	TELEPHONE: 747-922-1234
	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: DREAM HOME FOR SENIORS, LLC	FACILITY NUMBER: 197607861
	VISIT DATE: 01/07/2025

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COMMON SPACES: At the time of the visit, common seating area and dining room furniture were
observed to be in good condition. The common spaces included the living room, dining area, activity room, entertainment room and office area. The LPA observed cameras in all common spaces and exterior. The LPA did not observe the required postings in the common hallway and Administrator was aware they are required to post posting throughout facility upon admission. Fire extinguishers were observed to be fully charged. The backyard has a covered outdoor area equipped with furniture for resident use. There are no bodies of water noted.

KITCHEN: Appliances in the kitchen appeared functional. The supply of perishable and nonperishable food is adequate. LPA observed a locked drawer and cabinet for knives and medications. LPA advised Administrator to replace the locks as they were faulty at times.

INTERVIEWS: No residents interviews as facility has no residents.

RECORDS: No residents file reviewed as facility has no residents.

MEDICATION REVIEW: No medication reviewed as facility has no residents.

No citations were issued during today’s visit.

Exit interview conducted, and a copy of the report provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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