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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610150
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:50:49 AM

Document Has Been Signed on 03/04/2025 11:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CALIFORNIA DREAM ASSISTED LIVINGFACILITY NUMBER:
197610150
ADMINISTRATOR/
DIRECTOR:		AGHABEKYAN, GAYANEFACILITY TYPE:
740
ADDRESS:7043 TAMPA AVETELEPHONE:
(818) 300-8393
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 4DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Rima Agaronyan, Administrator DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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At 9:30 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator Designee Rima Agaronyan and explained the reason for the visit. Physical tour was conducted with the Administrator Designee and LPA observed the following:

Kitchen: 9:40 AM, LPA toured the kitchen area. The kitchen contained two refrigerators with adequate supplies of staple non-perishable for minimum 1 week and perishable for 2 days. The laundry room is located next to the kitchen and LPA observed all detergents and cleaning supplies were locked and inaccessible to residents in care. LPA obsreved a fully charged fire extinguisher in the office area which located in the living room and was last purchased on 09/07/2024.

Medications: At 9:45 AM, LPA observed a locked office where all residents medications were locked and inaccessible. LPA also observed residents and staff files locked and available for review.

Bedrooms: The facility had five (5) bedrooms. One (1) bedroom is designated for staff. The staff bedroom was locked and contained no hazardous items. Bedroom #2 and bedroom #3 are shared and bedroom #1 and bedroom #4 are private. All bedrooms contained adequate storage space, clean linens, televisions, nightstands, and lamps. Bedroom #1, bedroom #2, and bedroom #3 had exit doors in the room with ramps leading out.

Bathrooms: The facility had two (2) bathrooms. Both bathrooms contained fully stocked soap, paper towels, trash can, non-skid mats, and grab bars. LPA observed trash cans with tight fitting lids, -Hot water temperature measured at 117.3°F.

Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CALIFORNIA DREAM ASSISTED LIVING
FACILITY NUMBER: 197610150
VISIT DATE: 03/04/2025
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Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:22 AM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational.

Outside space: LPA observed a covered patio area for visitation and an extra table with furniture in good repair. All outdoor spaces and paths were from obstructions.

Garage: LPA observed a garage with adequate incontinence supplies and PPE.

Between 10:30 AM to 12:00 PM, LPA reviewed records of four (4) residents and two (2) staff. Residents and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

No deficiency cited during today’s visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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