306006213-5-8-2025-22-AS-BLOZ-DGGUKF-20250508153904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006213
Report Date: 05/08/2025
Date Signed: 05/08/2025 03:40:02 PM

Document Has Been Signed on 05/08/2025 03:40 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 AMERICA		FACILITY NUMBER:	306006213
ADMINISTRATOR/ DIRECTOR:	FAZELI, TALA		FACILITY TYPE:	775
ADDRESS:	18 GOODYEAR STE 115		TELEPHONE:	(949) 398-7067
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY: 140		CENSUS: 73	DATE:	05/08/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Assistant Program Director Jordan Herman		TIME VISIT/ INSPECTION COMPLETED:	03:53 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) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Assistant Program Director (APD) Jordan Herman was present and assisted LPA with the inspection. The facility is an Adult Day Program (ADP) licensed for 140 ambulatory clients. The facility operates from Monday through Friday, 9 AM to 3 PM. The facility is a two story commercial building located in an office park. The first level of the facility includes a reception area, a movie room, three activity areas, a staff break room, and four shared client bathrooms. The second story of the facility includes a library, a classroom area, and five staff offices. LPA, accompanied by the APD, conducted a tour of the physical plant. On today's visit, LPA observed clients participating in activities including creating flower arrangements for Mother's day. LPA inspected all three activity areas, the reception area, the movie room, and the staff break room and observed them to be clear of hazards. LPA observed that chemicals and toxins are stored in a locked storage room. LPA observed a First Aid Kit to be stored in a cabinet near the reception area and it had all the required components. LPA inspected the four shared client bathrooms and observed them to be clear of hazards. Faucets and toilets were operational. Hot water temperature measured between 107.7 and 108.3 degrees Fahrenheit. LPA inspected the the library, the classroom area, and the five staff offices on the second level and observed them to be free of hazards. LPA observed the facility to be maintained in good repair. There are three fire extinguishers located on the first level and there are two fire extinguishers located on the second level. LPA observed fire extinguishers to be charged and serviced as of January 24, 2025. CONTINUED ON 809-C.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: DREAMS OF AMERICA	FACILITY NUMBER: 306006213
	VISIT DATE: 05/08/2025

NARRATIVE

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LPA observed the Fire Service Marshall conducted their annual inspection on September 19, 2024. The annual inspection consist of testing the water sprinkler system which tested operational. LPA tested the individual carbon monoxide detectors on the first and second level which tested operational. There is no food service at the facility and clients bring their own prepared lunch or will have outings to purchase lunch. The facility provides two microwaves and a refrigerator for clients use. LPA observed appliances to be clean and operational. The facility does not assist with clients with medications. There facility does not assist with clients Personal and Incidental expense monies (P&I).

LPA reviewed all seven client files. All the required documentation were present and current in the client files reviewed. LPA reviewed seven staff files. LPA observed Staff #1 (S1), Staff #3 (S3), Staff #5 (S5) and Staff #7 (S7) did not complete the required annual training for the year of 2024. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, one deficiency is being cited on the attached 809-D. An exit interview was conducted with Assistant Program Director Jordan Herman. A copy of the report and Appeal Rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/08/2025 03:40 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!

Created By: Brandon Lopez On 05/08/2025 at 03:23 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: 306006213
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Under Appeal

Type B

Section Cited

CCR

82065.1(d)(1)

Personnel Qualifications and Duties

(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During staff file review, LPA observed that Staff #1 (S1), Staff #3 (S3), Staff #5 (S5), and Staff #7 (S7) did not complete the required annual training for the year of 2024.
	POC Due Date: 05/16/2025
	Plan of Correction
1 2 3 4	APD agreed to create a statement of understanding for the regulation. APD agreed to submit the statement of understanding to LPA via email or fax by POC 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.

	Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:

	Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC809 (FAS) - (06/04)

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