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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802000
Report Date: 12/22/2022
Date Signed: 12/22/2022 04:05:31 PM

Document Has Been Signed on 12/22/2022 04:05 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:DREAM HAVEN OF SANTA PAULAFACILITY NUMBER:
565802000
ADMINISTRATOR:GRACE CATABAYFACILITY TYPE:
740
ADDRESS:404 E. MAIN STREETTELEPHONE:
(805) 420-9605
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY: 6CENSUS: 6DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Jocelyn ReyesTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced Required 1-Year inspection. This annual had a specific emphasis on infection control practices and procedures. LPA met with staff Jocelyn Reyes (S1) and spoke with Licensee/Administrator Grace Catabay over the phone. LPA explained the reason for the visit. The licensee was unable to attend the visit and instructed LPA to conduct the visit with S1. The LPA, along with S1 and staff 2 (S2), toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN/FOOD SERVICE AREA: The facility had a sufficient supply of perishable food and non-perishable food. Knives and cleaning supplies were locked in drawers and cabinets. .
COMMON AREAS: The living room areas and dining areas are furnished appropriately. The smoke alarm and carbon monoxide detectors were tested and were operational. The fire extinguisher is fully charged and purchased on 11/19/2022. The backyard area is enclosed with a self-latching gate and outdoor activity space. Medications were locked and centrally stored in the hall closet. Cleaning supplies are stored in the locked laundry room.
BATHROOMS: There are three full bathrooms. The bathrooms were observed to be safe and sanitary with grab bars and non-skid mats and a supply of toilet paper, soap and paper towels.
BEDROOMS: There are six private resident bedrooms that were properly furnished at the time of the visit.
INFECTION CONTROL: During today’s visit, the LPA spoke with S1 regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and hand sanitization. LPA observed all staff to be wearing masks. LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. To date, the facility has not had a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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