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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006099
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:56:26 PM

Document Has Been Signed on 04/11/2024 02:56 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DREAMS OF AMERICAFACILITY NUMBER:
306006099
ADMINISTRATOR/
DIRECTOR:		FAZELI, TALAFACILITY TYPE:
775
ADDRESS:14 GOODYEAR SUITE 110TELEPHONE:
(949) 500-7067
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 140CENSUS: 25DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Monroe Pendar FazeliTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Joseph Alejandre conducted an unannounced Case Management – Incident inspection for the purpose of a health and safety check and to follow up on a self reported incident report received in the Orange County Regional Office regarding an incident involving Client #1 (C1). LPA met with the CEO Monroe Pendar Fazeli and explained the reason for the visit.

LPA and CEO toured the facility. LPA observed the facility has electricity, heating and air conditioning and water and phone service. Facility phone number 949-398-7698. LPA verified all staff are background cleared and associated to the facility. LPA did not observe any obstacles or hazards inside of the facility. LPA did not observe any deficiencies during the visit.

LPA requested copies of the client roster, staff roster, client files, and staff files.

There were no health and safety concerns observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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