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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880571
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:43:45 PM

Document Has Been Signed on 06/23/2022 12:43 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:
06/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Administrator- Romeo LabastidaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted a visit to the address 12029 Dressage Lane Riverside CA 92503 for a pre-licensing change of ownership for the facility "A Dressage Home Care".

During the pre-licensing inspection LPA toured the garage along with facility administrator and noted a storage room in the garage which was not noted on the facility sketch. LPA inquired about building permits or notification to the department of altercations to the facility for this storage room. Documentation was not provided to the LPA at the time of the visit. Facility will receive a deficiency for alterations to the facility. This will be detailed on an LIC809-D page.


An exit interview was conducted with facility Administrator Romeo Labastida, where this report along with deficiency pages and appeal rights were reviewed and provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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 2
Document Has Been Signed on 06/23/2022 12:43 PM - It Cannot Be Edited


Created By: Janira Arreola On 06/23/2022 at 12:04 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A DREAMLAND CARE VILLA
FACILITY NUMBER: 331880571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2022
Section Cited
CCR
87305(a)

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87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. The above regulation was not met as evidenced by:
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Licensee will submit proof of removal by poc date.
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LPA observed a storage room in the garage that was not noted on the facility sketch and which had no building permits provided to LPA.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Janira Arreola
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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