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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608797
Report Date: 05/16/2022
Date Signed: 05/16/2022 12:53:31 PM


Document Has Been Signed on 05/16/2022 12:53 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:DREAM HOME BOARD AND CAREFACILITY NUMBER:
197608797
ADMINISTRATOR:KARINE ASLANYANFACILITY TYPE:
740
ADDRESS:22812 SATICOY STREETTELEPHONE:
(818) 370-9117
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 4DATE:
05/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Edgar GasparyanTIME COMPLETED:
11:48 AM
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At approximately 11:20 a.m. on 05/16/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Plan of Correction (POC) visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. LPA was screened upon entry. LPA observed 3 out of 3 staff wearing masks.

At approximately 11:40 a.m. administrator showed LPA both exit gates were unlocked. Administrator explained that one key unlocks all doors, and staff were informed.

At approximately 11:45 p.m. LPA observed all medications locked in central storage in the dining room.

At approximately 12:00 p.m. administrator noted that the facility had maintained a screening station for over a year, but had since removed the station. LPA explained the necessary components of the station, and administrator to show proof of correction by POC due date.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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