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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608797
Report Date: 09/10/2026
Date Signed: 09/15/2026 10:09:15 AM

Document Has Been Signed on 09/15/2026 10:09 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DREAM HOME BOARD AND CAREFACILITY NUMBER:
197608797
ADMINISTRATOR/
DIRECTOR:		KARINE ASLANYANFACILITY TYPE:
740
ADDRESS:22812 SATICOY STREETTELEPHONE:
(818) 370-9117
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY: 6CENSUS: DATE:
09/10/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Edgar Gasparyan/LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tihesha Smith and Licensing Program Manager (LPM) Naira Margaryan made an unannounced case management visit to this facility. Fire inspector Lindsay Pelegrini joined the licensing representatives during visit. Upon arrival, construction workers were observed actively performing work in the back area of the property.

Prior to the visit, licensing staff reviewed the facility’s previously approved sketch and fire clearance documents. These were compared with the newly submitted sketch, and several changes were identified between the original physical plant layout and the recent submission.

The licensee was not present, however, LPM Margaryan spoke with the Licensee over the phone, explained that the purpose of this visit was to conduct follow up inspection and to clarify the status of the construction and renovation to the existing dwelling. After explaining the purpose of the visit, the Licensee allowed LPM Margaryan to enter the facility through the back patio door. While inspecting the facility, LPM continued communicating with the Licensee by phone.

The property has been converted from a five-bedroom, two-bathroom home to a four-bedroom, three-bathroom layout. Two bedrooms are designated for double occupancy, and the remaining two bedrooms are designated as private rooms. During the inspection, LPM verified that the physical plant changes observed on site are consistent with the updated sketch submitted to the Licensing Office.

Naira Margaryan
Tihesha Smith
DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2026
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DREAM HOME BOARD AND CARE
FACILITY NUMBER: 197608797
VISIT DATE: 09/10/2026
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(cont from 809)

The Licensee stated that the permit for the converted garage was previously pulled and approved. The Licensee further reported that permit applications for the interior conversion of the home have been submitted and that he is currently working with the Los Angeles Department of Building and Safety to complete required corrections in order to finalize the permits.

LPM Margaryan informed the Licensee that although the facility currently has no residents, the facility license remains active. Therefore, pursuant to Title 22, California Code of Regulations prior to beginning any construction and/or renovation to a licensed facility the licensee must contact the Licensing Office for approval.

LPM Margaryan also advised the Licensee that follow-up actions will be required once the construction project is finalized.

1. Once DSS receives the final permit(s), DSS will verify the information with LADBS.

2. The Licensee must request a new fire clearance by submitting LIC 200 along with a new facility sketch. The sketch must clearly show how the licensed facility will be separated from the ADUs located at the rear of the property and identify all exits for both the facility and the ADUs.

3. A fire inspector will conduct an on-site inspection to review and approve the request.

4. Upon approval, the Licensing Office will update the facility records.

5. A new license will be issued reflecting the approved changes. The Licensing Department may conduct additional visits to verify that the physical plant mates the final approved sketch.

Licensee also was notified that a copy of this report will be e-mailed to him for manual signature.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Tihesha Smith
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC809 (FAS) - (06/04)
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