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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006099
Report Date: 06/17/2022
Date Signed: 06/17/2022 11:47:44 AM

Document Has Been Signed on 06/17/2022 11:47 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DREAMS OF AMERICAFACILITY NUMBER:
306006099
ADMINISTRATOR:FAZELI, TALAFACILITY TYPE:
775
ADDRESS:14 GOODYEAR SUITE 110TELEPHONE:
(949) 500-7067
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 140CENSUS: 52DATE:
06/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tala Fazeli and Monroe FazeliTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Program Director Tala Fazeli. President Monroe Fazeli arrived during the visit. An initial application to operate an Adult Day Program was received by CCL on 03/18/2022 for a capacity of 140 non-ambulatory clients. LPA was screened for Covid-19 upon entry and facility is following covid-19 protocols. Facility is a drop off point for clients who are escorted into the community daily with staff for activities such as bowling, work, exercise or gardening.
LPA Lyman and Program Director toured the facility at 9:15 AM and observed the following:
Structure: Facility is a two story building approximately 3400 square feet with four restrooms and multiple exits. There are multiple activity rooms with tables and chairs, televisions and computer. There is adequate seating and activity areas. Bathrooms: All client bathrooms have a working toilet/ wash basin and hand washing signs posted. Food Service: Facility does not prepare food for clients in-house. Clients bring their own lunch or food is obtained out in the community. LPA observed two refrigerators for storage as well as filtered water. Smoke Detectors: Facility is in a commercial building with sprinklers replacing typical smoke detectors. Sprinkler system is monitored quarterly and Fire Authority inspects annually. Fire inspection completed 02/25/2022. Fire extinguishers are mounted and charged. Facility has carbon monoxide detectors as well. Toxins/ Sharps: Locked/stored in secured cupboards. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. Facility does not store or administer medications. Resident & Staff File: Records are stored in a locked cabinet in management office. Reading Material, Games, and Equipment: Facility has ample activities and games present. Fire Clearance: Approved for 140 non-ambulatory residents on 02/25/2022.

Component III conducted during the visit.

Facility is ready to be licensed.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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