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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006099
Report Date:
05/18/2023
Date Signed:
05/18/2023 11:09:23 AM
Document Has Been Signed on
05/18/2023 11:09 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
ORANGE & INLAND A/SC
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
DREAMS OF AMERICA
FACILITY NUMBER:
306006099
ADMINISTRATOR:
FAZELI, TALA
FACILITY TYPE:
775
ADDRESS:
14 GOODYEAR SUITE 110
TELEPHONE:
(949) 500-7067
CITY:
IRVINE
STATE:
CA
ZIP CODE:
92618
CAPACITY:
140
CENSUS:
DATE:
05/18/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
09:18 AM
MET WITH:
Administrator, Tala Fazeli
TIME COMPLETED:
11:20 AM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit for the purpose of conducting a collateral visit in regards to open complaint investigations unrelated to current licensee. LPA Tirre met with Administrator Tala Fazeli and explained reason for the visit. President Monroe Fazeli and Assistant Program Director Jordan Herman were present during time of visit.
On this day LPA conducted interviews related to complaint control numbers:
·
22-AS-20210616163354
·
22-AS-20220720170822
·
22-AS-20230127104526
·
22-AS-20230316144047
·
22-AS-20230508090456
·
22-AS-20230516104324
Exit interview conducted with Administrator and copy of report along with copy of LIC 811 was provided to facility.
SUPERVISORS NAME
:
Luz Adams
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/18/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/18/2023
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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