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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006099
Report Date: 12/06/2022
Date Signed: 12/06/2022 03:14:40 PM

Document Has Been Signed on 12/06/2022 03:14 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, 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: 63DATE:
12/06/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Facility Supervisor-Denise MoronesTIME COMPLETED:
03:37 PM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required post-licensing inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 12 staff were on duty, who contacted facility administrator (AD) Tala Fazeli about visit. AD Fazeli was unable to be present during time of visit, however, provided consent for facility supervisor (S1) Denise Morone to receive and sign report. As of 12/6/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility.

LPA De Perio toured the interior portion of the facility with S1. NOTE: Facility does not utilize the exterior portion. The facility is a two level structure and is licensed for clients 18 years and older of which 140 may be ambulatory. Facility is an adult day program. On 12/6/22, facility had a census of 63 clients in care. Upon LPA De Perio's arrival, clients were being picked up from facility to go home. Facility has a designated pick-up and drop off location, which is located in the back. Facility utilizes taxis, buses, family members and facility vehicles as forms of transportation. On the first floor, LPA De Perio observed activity areas designated for client use and staff offices. The first floor also has a total of four bathrooms, of which were observed to be in good repair, toilets were operational. Water temperature in restrooms were measured at 107.2 degrees Fahrenheit and hand washing signs were also posted in each restroom. On the second floor, there is also an activity area and staff offices.

Smoke and carbon monoxide detector underwent an inspection on October 2022, of which was passed. Fire extinguisher was charged, mounted and located both on the first and second floor of the facility. Facility had back-up emergency water supply, located in a closet.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AMERICA
FACILITY NUMBER: 306006099
VISIT DATE: 12/06/2022
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LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the back of the facility, in the main activity room. Toxins were also observed to be locked and inaccessible to clients. LPA De Perio observed and verified that facility does NOT give medications to clients.

LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Fazeli via phone and S1.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued.

LPA De Perio discussed with AD Fazeli and S1 to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov.

LPA De Perio discussed the California Code of Regulations Section 85075.4 Observation of the Client and Sections 80061 and 85061 Reporting Requirements with AD Fazeli via phone and S1.

LPA De Perio advised AD Fazeli to use the general email address:
CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA.

LPA De Perio conducted an exit interview with AD Fazeli and S1 and a copy of this report, and copies of the regulations discussed were provided to the facility.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
LIC809 (FAS) - (06/04)
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