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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880571
Report Date: 08/22/2022
Date Signed: 08/22/2022 02:42:33 PM


Document Has Been Signed on 08/22/2022 02:42 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:A DREAMLAND CARE VILLAFACILITY NUMBER:
331880571
ADMINISTRATOR:ROMEO LABASTIDAFACILITY TYPE:
740
ADDRESS:12029 DRESSAGE LNTELEPHONE:
(951) 751-5875
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 4DATE:
08/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Labastida Romeo, AdministratorTIME COMPLETED:
02:55 PM
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Licensing Program Analyst Yolanda Delgado arrived to the facility to conduct an unannounced visit to the facility to complete the Annual Inspection with an emphasis on Infection Control. LPA was met by Administrator Labastida Romeo and was explained the purpose of the visit. LPA was informed that they had a Change of Ownership with a new license, Administrator provided document of the new license for A Dressage Home Care-331881301 on June 23, 2022. LPA conferred with LPM Harris on the matter. LPA Delgado will be doing the close out report for A Dreamland Care Villa-331880571. Currently there are four (4) residents in care and four (4) staff present, current staff verified with Guardian roster. LPA conducted a tour and observed four (4) residents in care, LPA observed the refrigerator with perishables and non-perishables for residents. There are working utilities. Administrator surrender license to LPA. LPA Delgado will confer with current assigned LPA Arreola.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022
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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