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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006213
Report Date: 04/11/2024
Date Signed: 04/11/2024 04:39:44 PM

Document Has Been Signed on 04/11/2024 04:39 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:
306006213
ADMINISTRATOR/
DIRECTOR:		FAZELI, TALAFACILITY TYPE:
775
ADDRESS:18 GOODYEAR STE 115TELEPHONE:
(949) 398-7067
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 140CENSUS: 0DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:10 PM
MET WITH:Jordan HermanTIME VISIT/
INSPECTION COMPLETED:
04:39 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 to follow up on a self reported incident report received in the Orange County Regional Office regarding an incident involving a client. LPA met with the Assistant Program Director Jordan Herman and explained the reason for visit.

LPA and Assistant Program Director toured the facility. There were no clients present during the visit. LPA observed the facility has electricity, heating and air conditioning and water. LPA verified 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 obtained copies of the client roster and staff roster.

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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