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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006398
Report Date: 01/23/2024
Date Signed: 01/23/2024 11:07:19 AM

Document Has Been Signed on 01/23/2024 11:07 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:
306006398
ADMINISTRATOR:FAZELI, TALAFACILITY TYPE:
775
ADDRESS:8929 IRVINE CENTER DR.TELEPHONE:
(949) 398-7698
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 70CENSUS: 0DATE:
01/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jordan Herman
Jillian Rivero
Tala Fazeli		TIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Assistant Program Director (APD) Jordan Herman and Operations Manager (OM) Jillian Rivero. Designated Administrator (AD) Tala Fazeli and President (PR) Monroe Fazaeli arrived at 9:15 a.m. An application to operate an Adult Day Program (ADP) for (70) capacity, (70) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by CCL on 8/03/2023.

Structure:
The facility is a two-story commercial building. The first story consists of one lobby, one main room, one game room, one client store, one client job training room, one staff copy room, one storage room, two bathrooms, one client kitchen area, one client cubby room, and one conference room. Second story consist of three staff offices, one lounge room, one computer room, two storage rooms, two bathrooms, one kitchen area for staff, and one conference room. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the lobby.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and stored in locked storage rooms.

Medications, First-Aid Kit & Book:
Facility will not manage client medications. First aid kit is stored in a cabinet in the client kitchen area. The first aid kit has all the required elements.

Resident & Staff Files:
Records will be kept in a locked file cabinet in a staff office upstairs.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AMERICA
FACILITY NUMBER: 306006398
VISIT DATE: 01/23/2024
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Pool/Jacuzzi:
No bodies of water were observed.

Fire Extinguisher:
Fire extinguishers were observed mounted on the wall upstairs and downstairs, and were fully charged with service tags dated 7/19/23.

Reading Material, Games, Equipment & Materials:
The facility has board games, puzzles, and other recreational materials for client’s use and will be stored in the game room.

Fire clearance:
Was approved by a fire inspector of Orange County Fire Authority (OCFA) on 09/12/2023. No special conditions noted.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements.

Bathrooms:
All bathrooms have working plumbing and hot water measured between 112.1-116.6-degrees Fahrenheit.

Emergency Phone Numbers, Exit Plan & Menu:
Posted and available, means of exiting and emergency phone numbers. Facility will not provide food service.

Smoke Detectors:
Smoke detectors are on a sprinkler system and were inspected by OCFA on 9/12/23. Carbon monoxide detectors tested operational.

Appliances:
Refrigerator and microwave are operational.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AMERICA
FACILITY NUMBER: 306006398
VISIT DATE: 01/23/2024
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The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC809 (FAS) - (06/04)
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