306006099-7-27-2023-22-AS-SHAD-CU5UAU-20230727152518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006099
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:25:28 PM

Document Has Been Signed on 07/27/2023 03:25 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 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: 70	DATE:	07/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Michael Newton, Jordan Herman		TIME COMPLETED:	03:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Staff #1 (S1) Michael Newton and discussed the purpose of the inspection. Assistant Administrator (AA) Jordan Herman arrived during the inspection. LPA reviewed Infection Control requirements. At about 10:30AM, LPA and AA conducted a tour of the inside and outside of the facility, common areas, storage areas, and bathrooms and observed the following: Structure: this is a large commercial facility which houses one day program. Facility has 6 common areas, multiple storage areas. 2 offices, and 4 bathrooms. The structure does not include any outside areas. The program hours are Monday through Friday, 8AM to 3PM. Morning and afternoon activities take place at the facility, but the program is community-based so clients and staff engage in activities outside in the community. LPA observed 3 staff and 2 clients present at the facility during the inspection because the clients are currently in the community. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 127.5 degrees F at the South West bathroom faucet, 129 at the South East bathroom, 145 at the North West bathroom, and 138 at the North East bathroom. LPA inspected all rooms in the facility. Emergency Phone Numbers and Exit Plan: reviewed. Food Service: this facility does not provide food service. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: microwave inspected. Knives: there are no knives at the facility. Toxins: observed locked in the cleaning closet. Medication cabinet: facility does not handle medications. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 1:00PM, LPA reviewed 5 client files and 5 staff files and interviewed 2 clients and 3 staff. Facility does not handle client medications or money.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 7

Document Has Been Signed on 07/27/2023 03:25 PM - It Cannot Be Edited

Created By: Sean Haddad On 07/27/2023 at 01:59 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DREAMS OF AMERICA	FACILITY NUMBER: 306006099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82019(e)(3)

Criminal Record Clearance

(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews and documents, the licensee did not ensure 19 staff were associated to the facility, which poses an immediate health and safety risk to persons in care. CIVIL PENALTY ASSESSED.
	POC Due Date: 07/28/2023
	Plan of Correction
1 2 3 4	Licensee already performs background checks, including driving record and drug tests, for each staff hired. Licensee stated they will immediately have all staff associated to the facility and will submit proof to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Armando J Lucero

LICENSING EVALUATOR NAME:

Sean Haddad

LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

Document Has Been Signed on 07/27/2023 03:25 PM - It Cannot Be Edited

Created By: Sean Haddad On 07/27/2023 at 01:59 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DREAMS OF AMERICA	FACILITY NUMBER: 306006099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not ensure 4 out of 4 bathroom water temperatures did not exceed 120 degrees F, which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/10/2023
	Plan of Correction
1 2 3 4	Licensee stated they will work with maintenance to correct the water temperature and submit temperature logs to LPA by POC due date.

Type B

Section Cited

CCR

82065(g)(1)

Personnel Requirements

(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on documents, 0 out of 5 staff files contained completed health screenings, which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/10/2023
	Plan of Correction
1 2 3 4	Licensee stated they will obtain health screenings for all staff and submit proof to LPA by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Armando J Lucero

LICENSING EVALUATOR NAME:

Sean Haddad

LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 7

Document Has Been Signed on 07/27/2023 03:25 PM - It Cannot Be Edited

Created By: Sean Haddad On 07/27/2023 at 01:59 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DREAMS OF AMERICA	FACILITY NUMBER: 306006099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82069(a)

Client Medical Assessments

(a) Prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client that determines the licensee's ability to provide necessary health-related services to the client. The assessment shall be used in developing the Needs and Services Plan. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and records, the licensee did not ensure 5 out of 5 client files contained physician's reports, which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/10/2023
	Plan of Correction
1 2 3 4	Licensee stated they will obtain physician's reports for all clients and submit proof to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Armando J Lucero

LICENSING EVALUATOR NAME:

Sean Haddad

LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: 07/27/2023

NARRATIVE

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During the inspection, LPA and AA observed the following: the water temperature tested at 127.5 degrees F at the South West bathroom faucet, 129 at the South East bathroom, 145 at the North West bathroom, and 138 at the North East bathroom; 0 out of 5 staff files contained completed health screenings; and 0 out of 5 client files contained physician's reports. During the inspection, LPA and AA reviewed records showing the facility performs background checks, including driving record checks and drug tests, for each staff hired. However, based on Guardian records, the background clearances of 19 staff have not been associated to this facility license. Licensee began the process of associating the 19 staff during the inspection.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

Page: 7 of 7