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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435294351
Report Date: 07/31/2026
Date Signed: 08/01/2026 04:23:59 PM

Document Has Been Signed on 08/01/2026 04:23 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SWEET DREAMS CARE HOME LLCFACILITY NUMBER:
435294351
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, DIVINAFACILITY TYPE:
740
ADDRESS:1187 PARK GROVE DRIVETELEPHONE:
(669) 226-5521
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 6DATE:
07/31/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:Divina FernandezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Steve Chang and Licensing Program Manager (LPM) Romeo Manazano conducted an unannounced case management visit and met with Administrator (ADM) Divina Fernandez.

During inspection of resident's (R1) bedroom (#3 as specified in facility floor plan), and bathroom, a box of prescribed medication was found inside the bathroom cabinet unlocked. According to R1's physician report 9/12/2025, R1 is able to store and administer medication, however, R1 has neurological disorder. ADM stated that they will contact R1's physician and/or responsible party to clarify. ADM also added that R1 will not be able to determine when and what to take. Also, LPA/LPM observed a can of comet (cleaning solution) on top of sink counter accessible. R1 lacks awareness and unable to access toxic materials.

During inspection of the facility bedrooms, LPA/LPM observed that full bed rails for two residents R2 and R3, while the rest of the residents, R4 to R6 has half bed rails. R2 has a medical note for the hospital bed but the rest of the residents does not have medical notes. ADM stated that they are both utilizing bed rails for mobility and safety. In addition, R2 was observed utilizing a wheelchair with a seat belt. R2 stated that he/she need it for his/her safety. R2 stated that his/her son who works for an airline, so he/she is aware of wearing a buckle seat belt for his/her safety. R2 is alert and oriented but when asked if he/she is able to release seat belt, he/she said he/she unable to unbuckle due to weakness. ADM stated that there is no medical note for the seat belt.

Page 1 of 2, See continuation on LIC809-C
Romeo Manzano
Chihhsien Chang
DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2026
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 6
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351
VISIT DATE: 07/31/2026
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LPA/LPM also inspected the staff bedroom across bedroom #5. The back exit door can be access through staff bedroom, bedroom #6 and between staff and bedroom #6 [Note: back exit is located in staff bedroom with ramp outside]. Since staff bedroom is the main exit leading to the back exit, LPA/LPM informed ADM that staff bedroom cannot be locked and the back exit door shall have one single door knob mechanism. LPA/LPM also reminded ADM to ensure that staff medications and toxins must be locked at all times.

ADM provided a copy of an updated facility sketch which specifies the facility exits.

It was also noted that bedroom#4's cabinet door is loose or not in good repair [not closing properly]. ADM stated that it will be fixed this weekend.

Deficiencies were issued during today's visit, SEE LIC809-D. Exit interview was conducted with ADM. Appeal Rights information was provided.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Chihhsien Chang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/01/2026 04:24 PM - It Cannot Be Edited


Created By: Chihhsien Chang On 07/31/2026 at 12:19 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2026
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care (h)(2) Centrally stored medicines 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. During inspection visit, resident's(R1)
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Administrator agrees to provide a plan of correction by the POC due date (08/01/2026) to CCL office and provides the staff training log to CCL office. ADminstrtor stated the facility will instruct all staff to check each resident room every 4 hours and keep a checking log.
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During the visit, medication was found in the his/her bathroom in bedroom #3 accessible. Although R1 states he/she is able to administer and store his/her own medication, it was not locked which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
08/01/2026
Section Cited
CCR87309(a)

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87309 Storage Space and Access
the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Administrator agrees to provide a plan of correction by the POC due date (08/01/2026) to CCL office and provides the staff training log to CCL office.Administrator stated the facility will instruct all staff to check each resident room regualrly to make sure there is no toxic measterial left in the resident rooms. Adminstrator stated will provide a log for the checking for every 4 hours.
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During the visit, LPA/LPM observed a can of comet accessible in bedroom#3's bathroom. toxins which could pose a danger to residents are in not locked storage and are not left unattended orage.disinfectant was found in the of resident room #3 and was accessible to resident which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Chihhsien Chang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 08/01/2026 04:24 PM - It Cannot Be Edited


Created By: Chihhsien Chang On 07/31/2026 at 01:37 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2026
Section Cited
CCR
87608(a)(3)

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87608 Postural Supports (a) (3)A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.
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Administrator agrees to provide a plan of correction by the POC due date (08/01/2026) to CCL office and to read Title 22 to understand the regulations. Adminstrator stated the facility will contact resident's doctor to get medical order. It will be ready in 7 days. Administrator stated the facility will make sure the resident is able to realese the seatbelt.
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During inspection visit, R2 was observed utilizing a wheelchair with seat belt. ADM stated there is no medical note for it. R2 is alert and oriented who stated he/she likes to have it for his/her safety but when asked if he/she can unbuckled, he/she unable due to weakness. which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Chihhsien Chang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2026


LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 08/01/2026 04:24 PM - It Cannot Be Edited


Created By: Chihhsien Chang On 07/31/2026 at 01:34 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: SWEET DREAMS CARE HOME LLC
FACILITY NUMBER: 435294351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2026
Section Cited
CCR
87608(a)(5)(B)

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87608 Postural Supports (a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.
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Administrator agrees to provide a plan of correction by the POC due date (08/01/2026) to CCL office and to read Title 22 to understand the regulations. Adminstrator stated the facility will contact residents' doctor to obtain the medical order which justify residents' condtion and needs for full bedrial and will be ready in one week.
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During inspection visit, there are two residents utilizing full bed rails (R2 and R3) due to safety concerns and are at risk of falling. Although, R2 has MD order but it does not specify the need for it which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
08/01/2026
Section Cited
CCR87608(a)(5)(A)

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87608 Postural Supports (a)(5)(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.
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Administrator agrees to provide a plan of correction by the POC due date (08/01/2026) to CCL office and to read Title 22 to understand the regulations. Administrator stated the faciity will contact residents' doctors to obtain medical order to use heal bedrail for mobility. It will be ready in one week.
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During inspection, R4 to R6 are utilizing 1/2 bedrails for both safety and mobility with no medical order which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Chihhsien Chang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6