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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006213
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:46:30 AM

Document Has Been Signed on 05/19/2023 10:46 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:DREAMS OF AMERICAFACILITY NUMBER:
306006213
ADMINISTRATOR:FAZELI, TALAFACILITY TYPE:
775
ADDRESS:18 GOODYEAR STE 115TELEPHONE:
(949) 398-7067
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 140CENSUS: 70DATE:
05/19/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Supervisor - Jose GarciaTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced collateral visit at the facility in conjunction with complaint: 22-AS-20230307163014.

LPA De Perio explained reason for visit, was greeted and granted entry by facility supervisor (S1) Jose Garcia, who notified Program Director Tala Fazeli about visit.

During this visit, LPA De Perio conducted interviews.

An exit interview was conducted with S1 Garcia. A copy of this report was provided and explained to S1 Garcia.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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