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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701398
Report Date: 07/30/2025
Date Signed: 07/30/2025 04:59:17 PM

Document Has Been Signed on 07/30/2025 04:59 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DREAMERS' HEARTHFACILITY NUMBER:
342701398
ADMINISTRATOR/
DIRECTOR:		SUGANOB, JESSIEFACILITY TYPE:
735
ADDRESS:11859 AUTUMN SUNSET WAYTELEPHONE:
(916) 225-8423
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 4DATE:
07/30/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jessie SuganobTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 07/30/25, Licensing Program Analyst (LPA) Kimberly Viarella visited this facility to conduct a post-licensing inspection. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator. LPA met with Jessie Suganob and a brief interview followed. There were currently 4 clients in residency although only two were present during this inspection; one was at their day program and the other was in the hospital. The two remaining left for an outing with the care giver to the park.

Administrator Suganob was present for the majority of this visit, however they had to leave for another commitment. The House Manager, Belinda Sibal remained to finish and participate in the exit interview.

LPA conducted a walkthrough of the facility. All resident rooms had the required furniture, furnishings, and lighting, to be in compliance at the time of this post-licensing inspection. LPA reviewed the Program Plan and noted that it did not contain information regarding infection control and provided technical assistance in this area. LPA reviewed the Emergency / Disaster Plan and provided technical assistance regarding additional details for evacuation locations.

LPA reviewed all staff files to ensure that each person had the appropriate background clearance. 14 were in compliance and 1 was pending. The last had their clearance letter form the Department of Justice, however they did not have a clearance letter from Community Care Licensing (CCL). LPA provided technical assistance regarding this matter and instructed the facility to wait until CCL approval was granted before allowing that employee to work.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2025
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DREAMERS' HEARTH
FACILITY NUMBER: 342701398
VISIT DATE: 07/30/2025
NARRATIVE
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LPA reviewed 3 staff files and all materials were in compliance at the time of this inspection.

During a tour of the facility, LPA observed 2 medication bottles in an unlocked cabinet in the kitchen. This deficiency was cited on the LIC809 D page.

The Licensee did not notify Community Care Licensing within 5 days of accepting their first resident. This deficiency was also cited on an LIC 809D page.

According to the California Code of Regulations, Title 22, no other deficiencies were observed during today's visit. A copy of this report was provided, along with APPEAL RIGHTS and an exit interview was conducted with the Designee / House Manager, Belinda Sibal.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2025 04:59 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 07/30/2025 at 01:39 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DREAMERS' HEARTH
FACILITY NUMBER: 342701398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(k)(1)
(k) The following requirements shall apply to medications which are centrally stored:
(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above when the LPA observed 2 prescription medications in an unlocked kitchen cabinet and accesible to residents in care. This posed / poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2025
Plan of Correction
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The medication was removed immediately and locked away, The House Manager stated they they will conduct a training that will explain to stafthat no medications may be left out and accessible to residents. The House Manager will supply Licensing with a letter stating when this training will take place and the names of those who will be participating. This will be submitted by 7/31/25 by fac or email to: CCLASCPSacramentoRO@dss.ca.gov.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2025 04:59 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 07/30/2025 at 02:01 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DREAMERS' HEARTH
FACILITY NUMBER: 342701398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1526.5
(a) Within 90 days after a facility accepts its first client for placement following the issuance of a license or special permit pursuant to Section 1525, the department shall inspect the facility. The licensee shall within five business days after accepting its first client for placement notify the department that the facility has commenced operating. Foster family homes are exempt from the provisions of this subdivision.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, and a record review, the licensee did not comply with the section cited above in when they admitted three residents without notifying Community Care Licensing within the required time frame. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/30/2025
Plan of Correction
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The Licensee responded to an inquiry made by this LPA on 06/25/25. The Licensee stated that they had admitted 3 residents during the month of June but had not yet notified Licensing. The Licensee will write an attestation that they have read and understand the above regulation. This will be submitted to Licensing by fax or emailed to CCLASCPSacramentoRO@dss.ca.gov by the close of business 08/06/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
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