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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197609680
Report Date:
10/19/2020
Date Signed:
10/19/2020 11:43:59 AM
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 SENIOR LIVING FACILITY
FACILITY NUMBER:
197609680
ADMINISTRATOR:
MADOYAN, ANNA
FACILITY TYPE:
740
ADDRESS:
7321 OSO AVE
TELEPHONE:
(818) 641-4265
CITY:
WINNETKA
STATE:
CA
ZIP CODE:
91306
CAPACITY:
6
CENSUS:
DATE:
10/19/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Anna Madoyan
TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Wendell Smith conducted a virtual closure visit via Face-time with administrator/licensee Anna Madoyan. Visit was conducted virtually do to the Covid-19 pandemic.
LPA was given a physical plant tour of the facility. LPA observed the facility to be empty of residents and that all resident belongings were moved out. Facility had only one resident as of August 2020 and that resident passed away on 9/29/2020. LPA sent administrator an email with the link to the closure survey. Administrator stated she would complete the survey by the end of today. Exit Interview conducted. Copy of report emailed. Signature on hard copy.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/19/2020
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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