306006213-5-1-2023-22-AS-RMAZ-CRESPV-20230501140346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006213
Report Date: 05/01/2023
Date Signed: 05/01/2023 02:03:54 PM

Document Has Been Signed on 05/01/2023 02:03 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 & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	DREAMS OF AMERICA		FACILITY NUMBER:	306006213
ADMINISTRATOR:	FAZELI, TALA		FACILITY TYPE:	775
ADDRESS:	18 GOODYEAR STE 115		TELEPHONE:	(949) 500-7067
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY: 140		CENSUS: 0	DATE:	05/01/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Tala Fazeli		TIME COMPLETED:	02:30 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	Licensing Program Analyst (LPA) Ruth Martinez arrived at facility and met with Tala Fazeli, Program Director for the purpose of conducting a Prelicensing inspection. An initial application to operate an Adult Day Program for 140 ambulatory clients was submitted to CCL on 07/18/22. Structure. The facility is located in a two story professional office building. It consists of a long open floor plan with rooms designed for multiple use areas for activities with clients. There is a reception area and adjacent to it is an area. There is a kitchen equipped with a refrigerator, sink, and microwave oven. There are storage cubies located on the first floor for clients use. Facility will operate Monday through Friday from 9:00 a.m. through 3:00 p.m. Beds for Client's Resting. Not available Bathrooms. Facility has 4 bathrooms on the first floor with a working toilet and sink. Emergency Phone Numbers & Exit Plan. Posted on the first floor. Appliances. Refrigerator and 2 microwaves. Continued on LIC809-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: 306006213
	VISIT DATE: 05/01/2023

NARRATIVE

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Food Service.
Clients will bring own food & snacks.

Drinking Water.
Available & located inside the building for clients use.

Water Temperature.
Tested at 118.5 Fahrenheit degrees.

Toxins.
Locked in the utility room located in the first floor inaccessible to clients.

Clients & Staff Files.
Will be locked/stored in the office located on the second floor.

Medications.
Facility will not handle medication.

First-Aid Kit & Book.
Facility has several first aid kits and book throughout the facility.

Reading Material, Games, Equipment & Materials.
Applicants have board games, magazines, books, televisions, music area, and arts and crafts for clients’ use.

Fire clearance
The fire clearance was approved on 09/23/22 for 140 ambulatory residents.

Parking and Waiting Area
The parking area will also serve a drop off and pick up area for the Clients.

Continued on LIC809-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: 306006213
	VISIT DATE: 05/01/2023

NARRATIVE

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Transportation
The Applicants will assist in providing transportation to clients.

Smoke Detectors.
The building has combination Smoke Detectors Sprinklers and Carbon Monoxide Detectors.

Component III:
Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities.

Facility appears to be ready for licensure. Accordingly, LPA will submit file for approval to CCL Supervisor.
Exit interview was conducted and a copy of this report was left with the applicant.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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