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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602967
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:51:01 PM

Document Has Been Signed on 11/08/2024 03:51 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DREAM CARE HOME LLCFACILITY NUMBER:
198602967
ADMINISTRATOR/
DIRECTOR:		CASTRO, MONAFACILITY TYPE:
740
ADDRESS:11838 163RD STTELEPHONE:
(562) 404-7010
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:44 PM
MET WITH:Administrator Mona Shelia Castro TIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced Required 1 year inspection at the facility and met with Administrator Mona Castro and explained the purpose for todays visit.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Plan in place.

Operational Requirements The facility is approved for AGE RANGE 60 AND OVER. APPROVED FOR 6 NON-AMBULATORY. HOSPICE WAIVER FOR 2 RESIDENTS. A Certificate of Liability Insurance was observed and a copy was obtained.


Due to time constraints, LPA will return at a later date to complete all (12) CARE Tool domains. Exit interview conducted with Administrator Mona Shelia Castro and a copy of this report was provided.
Fernando FierrosTELEPHONE: (323) 981- 3981
Tyler ReyesTELEPHONE: (323) 981-3306
DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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