Dream Care Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent case management visit in response to an initial case management dated 10/16/25 following the death of Resident #1 (R1), who passed away 8/7/25. LPA met with Licensee/ Administrator Mona Castro and explained the purpose for todays visit. On 10/8/25 the Department received a Death Report indicating the following: on 8/7/25 R1 was found on the street by a bystander and was complaining of abdominal pain, 911 was called and R1 was admitted to the hospital at 8:37am and was observed at the hospital for further evaluation and treatment. R1 was coded blue at 8:37pm and expired at 9:26pm. The cause of death was not specified, and Medical Records were forwarded to Administrator on 10/8/25. On 10/10/25 LPA Mallett conducted a telephone interview with Administrator Mona Castro. On 10/13/25 the department received the following documents from R1’s File via email: Admission Agreement, Physician Report dated 1/27/25, Appraisal Needs and Service Plan dated 4/2/25, Medication Administration Records (MAR) from May-August 2025, ID and Emergency Information dated 1/7/23. On 10/16/25 LPA’s Herrera and Mallett conducted an initial visit, conducted interview with Administrator, toured R1’s room and requested facility to obtain and provide Licensing with R1's Death Certificate upon receipt. On 1/14/26 LPA Herrera received a copy of R1’s Death Certificate dated 11/25/25 with the cause of death listed as: Congestive Heart Failure. Based on statements and interviews conducted with staff and review of R1's files and death report the cause of death does not appear to be suspicious or due to any neglect, therefore the findings are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elena Mallett conducted the required annual inspection. LPA arrived unannounced and met with Elfren Castro and explained the purpose for today’s visit, shortly after Administrator Mona Castro joined to assist with the visit. The facility is licensed to serve 6 Residents ages 60 and above with up to 6 bedridden. Bedridden can only be present in Rooms 1, 2 and3. The current census was 4 residents none of which are bedridden. The facility is a single-story home located in a residential area in Norwalk, Ca. A tour of the facility includes: 3 resident bedrooms, 1 resident bathroom, 2 private bedrooms, 1 stock room, 1 staff/resident bathroom, kitchen, dining area, living room, front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Continued on 809-C hInfection Control: Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance. The facility maintains the required liability insurance, current until 02/16/26. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. A chair,bed and adequate light was observed. Extra clean linens were observed. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors are operable and are not interconnected. The carbon monoxide detector was observed and operable and in compliance. There fire extinguisher was observed and is fully charged and checked on 06/11/2025. Staffing: There appears to be sufficient staffing at all times in the facility. A deficiency was noted.(See LIC-809D) Personnel Records-Training: Staff has criminal record clearance, current First-Aid training along with required initial and annual trainings documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Mona Casto's Administrator certificate is current and expires on 08/31/27. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Residents attend Day Program and are offered access to Senior Center. Technical Advisory given to incorporate more planned activities at the home. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. 4 residents' medical logs were checked with no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Disaster Drills are done quarterly. Last drill conducted 09/28/25 Residents with Special Health Needs: There are no bedridden or residents using hospice . One resident uses home health services at this time. In reference to the construction observed on the covered patio LPA Mallett asked Administrator Castro to submit to CCLD a plan that discussed how residents needs are affected by the construction, how this disruption will be mitigated and how long the project is estimated to take. Additionally, CCLD requests Administrator to send us a copy of completed Inspection report when all construction is completed. The current Fire Clearance for the facility states that Licensee will have an annual certification NFPA from Fire Alarm Company. This is to be completed by 04/17/2026. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was a deficiency cited during this visit. A Plan of Correction was discussed and agreed upon with the Administrator Castro. An exit interview was conducted with Administrator Castro and a copy of this licensing report and Appeal Rights were providedthe state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Tena Herrera and Elena Mallett conducted an unannounced Case Management Visit to follow up on a Death Report that was emailed to the Department on 10/8/25. LPAs met with Mona Castro and explained the reason for the visit. The Department received a Death Report dated 10/8/25 indicating the following: On 8/7/25 R1 was found on the street by a bystander and was complaining of abdominal pain, 911 was called and R1 was admitted to the hospital at 8:37am and was observed at the hospital for further evaluation and treatment. R1 was coded blue at 8:37pm and expired at 9:26pm. The cause of death was not specified and Medical Records were forwarded to Administrator on 10/8/25. On 8/5/25 the Department received a Special Incident Report (SIR) that indicated the following: R1 was having a regular day on 8/2/25, had a televisit with psychiatrist at 9am and was observed near dining room before 11:30am but was noticed by staff to have missed lunch. At 11:57 S1 went to search for R1 and later at 1pm Administrator conducted a search with no luck in locating R1. Family, hospitals and local police were all notified. Per LPA Herrera’s review of SIR’s and communication with the case carrying LPA Mallett no further SIR’s with updates have been received to the department. On 10/10/25 LPA Mallett spoke with Administrator Mona Castro and it was confirmed that there had been a phone call received on 8/26/25 by the pharmacy stating that insurance declined medication payment due to R1 being deceased. Administrator also confirmed that on 9/15/25 a contact that handles Assisted Living Waivers contacted the facility and asked that a death report be filed. Administrator explained that there was a conversation with R1’s emergency contact where they stated that R1’s SSI funds for the month of September had not been accessed which further suggested R1 passed away. (Continued on LIC809-C) On 10/13/25 the department received the following documents from R1’s File: Admission Agreement, Physician Report dated 1/27/25, Appraisal Needs and Service Plan dated 4/2/25, Medication Administration Records (MAR) from May-August 2025, ID and Emergency Information dated 1/7/23. Per the Administrator having continued updates on the possible whereabouts of R1’s status and not updating or reporting to the department LPA’s will be issuing a citation for a failure to report. Details will be found on the LIC809-D page. During todays visit LPA’s conducted a tour of R1’s bedroom, there were no concerns, obstructions, or anything out of the ordinary witnessed. LPAs have also requested facility to obtain and provide Licensing with R1's Death Certificate upon receipt. An exit interview, copy of the report, appeal rights and copy of LIC9098-Proof of Correction were provided to the Administrator.the state’s words, verbatim · CDSS document, Oct 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 30, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: During conversation with LPAs Herrera and Mallett, and Administrator, it was confirmed that on both 8/26/25 and 9/15/25 they were informed of the possible death of R1, in addition the conversation with R1’s emergency contact stating that R1’s SSI funds had not been accessed which brought the concern of a possible death; LPA’s review of SIR’s received by facility and administrator not reporting these updates to the department as required, this poses a potential health and safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: LPA provided a copy of the LIC9098-Proof of Correction form to Administrator during visit and Administrator is to review the Reporting Requirement Regulations and administer an in-service training to all staff on Reporting Requirements. Once review of regulation and in-service training is completed Administrator is to send a copy of the completed and signed LIC9098 and a copy of the in-service training log with names of participants, their signatures and date of training to LPA by POC due date. (email address: tena.herrera@dss.ca.gov)

Allegation investigated: Staff did not assist resident with obtaining medical care. Staff do not allow resident to have confidential telephone calls. Staff was mimicking the residents disability. Staff fabricated what happened between two residents. Resident was wrongfully evicted. Staff blocked residents phone number to prevent them from calling.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Administrator/Licensee Mona and explained the reason for the visit. The investigation consisted of the following: On 9/12/25 LPA interviewed 3 Staff (S1-S3) and 4 Residents (R1-R5) and obtained copies within Resident #1's file. R1 was not interviewed as they are no longer a resident at the facility and was not reachable. During todays visit 9/13/25 LPA delivered findings for the above allegations. (Continued on LIC9099-C page) Unsubstantiated Allegation: Staff did not assist resident with obtaining medical care. It is alleged that staff did not take R1 to their follow-up appointment regarding an injury to their hand. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that R1 was provided with assistance to follow up visit, however, R1 would constantly refuse doctors visits unless their POA would take them. Interview with S1 revealed that R1 would not go to any doctors appointments without their POA and during the time of this needed follow up the POA was not in town and could not take R1 to the appointment, when staff would ask to take R1 to the doctor, R1 would refuse. LPA was provided with a Special Incident Report (SIR) that documented the refusals from 2/16/25-2/23/25, the POA was able to have R1 agree to go to the doctor and on 2/24/25 R1 was admitted to the hospital for treatment to their hand. Hospital Records also document admission date of 2/24/25 for treatment to hand injury. S1 and S2 stated they were unaware of any other follow up appointments as R1’s POA is the person who sets and transports R1 to all appointments as it was never communicated to staff about an upcoming or missed doctor appointment. LPA spoke with R1’s POA and it was confirmed that they set the appointments and transport R1 to their appointments without notifying staff as they use their own physician and not the physician the facility offers to residents. LPA interviewed 4 residents each resident denied the above allegation and stated that they are provided with medical care and assistance in making appointments if needed. Allegation is unsubstantiated. Allegation: Staff do not allow resident to have confidential telephone calls. It is alleged that when calls are made for R1 staff will put the phone on speaker to listen to the conversation. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that when residents receive phone calls they are given the phone and typically the residents walk away, into their rooms, living room or porch, staff stated they do not follow to listen in on calls nor do they put the phone on speaker. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation and stated that they are given privacy when they have phone calls, R5 stated they have their own cell phone and are never asked to be in presence of staff when speaking on the phone. This allegation is unsubstantiated. Allegation: Staff was mimicking the resident’s disability. It is alleged that S1 was speaking with on the telephone regarding R1 and S1 mocked R1’s speech impediment. LPA interviewed 3 staff and each denied the above allegation stating that they have never mimicked or made fun of any of the residents or seen another staff do this. S1 stated they have never mocked residents. LPA interviewed 4 residents and each resident denied the above allegation, they stated they have never felt mocked, intimidated or made fun of by the staff and have never seen staff do that to another resident. This allegation is unsubstantiated. (Continued on the LIC9099-C page) Allegation: Staff fabricated what happened between two residents. & Allegation: Resident was wrongfully evicted. It is alleged that staff fabricated an altercation between R1 and another client in attempt to have R1 evicted and that on 4/14/2025, a 30-day eviction notice was received from the facility for R1 because of an altercation that R1 was a victim of. LPA interviewed 3 staff and each staff denied the above allegation and stated that leading to the eviction notice being provided to R1 there was a shift in behaviors where R1 was becoming more verbally aggressive towards staff and other residents. LPA was provided with SIRs and a copy of the Eviction Notice. Incident report dated 6/9/22 revealed that on 6/9/22 R1 entered the restroom while R4 was using it and got upset pushed R4 against the wall causing damage to the wall (photos of damage were also provided and observed). Incident report dated 2/15/25 revealed that on 2/15/25 R1 was upset and agitated with R4 as they were sitting in their seat in the living room, R1 became verbally aggressive and then physically assaulted R4 and R1 got injured in the process of hitting R4, emergency personnel were called and R1 was sent to the hospital. Staff stated that after the altercation R1 would continuously taunt, harass and be verbally aggressive to R4 and they became fearful for both residents safety, given R1s aggressive behaviors and violating the House Rules (Residents are to treat all residents, staff and guests with respect. Violent and harassing behaviors toward fellow residents and staff is considered a direct violation of House Rules) a 30-day eviction notice was provided on 4/11/25 with an effective date of May 11,2025, R1s last day in the facility was May 5, 2025 . LPA spoke with R1s POA and they stated that they are unsure if the reason for departure was because of the eviction and they were never forcefully removed from facility as they found a more suitable placement for R1. LPA interviewed 4 residents and each denied the above allegations and stated that they have never been issued an eviction notice, been threatened with eviction and do not feel staff would fabricate stories. Interviews with R2 and R3 revealed that R1 had history of instigating arguments with other residents and being verbally aggressive. R3 stated they had witnessed R1 being aggressive with R4 and R4 would not engage in the aggressive behavior. Both allegations are unsubstantiated. (Continued on LIC9099-C page) Allegation: Staff blocked residents phone number, to prevent them from calling. It is alleged that the facility intentionally blocked R1’s Power of Attorney (POA) phone number so that the POC cannot call and speak to R1. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that they never blocked anyone’s number from the facility phone. S2 stated they believe R1 may have accidentally blocked the number while using it one day as R1 had a habit of pressing buttons on the cordless phone, there is a block button on the phone and its possible that it was mistaken for the end button as both are red. LPA inspected phone and observed 2 buttons in red, one that read end and the other that read block. S1 stated that although there was a mix up with the facility phone R1s POA was provided with the cellphone numbers for S1-S3 so that phone calls can be made with no issues until the problem was resolved. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation and stated that they have never had issues with staff blocking any of their calls and have been able to use the facility phone with no issues. This allegation is unsubstantiated. Based on statements and interviews conducted with staff/residents and review of resident files, there was not enough supportive evidence to concur with the reported allegations. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 13, 2025 · control 28-AS-20250415103132

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA's) Nicol Wesley and Glenn Trueman conducted a case management visit at the facility and met with Mona Castro and Flor Castro. The purpose for todays visit is to verify if the Licensee's are complying with the L.A. Fire departments inspection report. On 03/26/25 Evette Almaraz conducted a visit at the facility, the fire inspector rescinded the non-ambulatory fire clearance and only approved the facility to have six ambulatory residents. Therefore, since the facility currently has a non-ambulatory resident the facility is operating beyond the limitations of the fire clearance. On 03/27/25 the fire inspector sent the report to Community Care Licensing Division and the Dream Care Home, LLC. We asked Mona Castro and Flor Castro if they have given a 30 day notice to resident #1. They answered no, but they were in contact with the daughter for resident #1. They did not provide proof that a 30 day notice was given to resident #1, or that they have been contacting facilities for the resident to move into. The following deficiency was cited in accordance to title 22, Division 6, Chapter 8. Appeal rights given. Exit interview conducted. The Licensee's refused to sign.the state’s words, verbatim · CDSS document, Apr 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(b) · Plan of correction due date: Apr 15, 2025

Limitations - Capacity and Ambulatory Status.Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement was not met as evidence by: On 04/10/25 Lisa Hicks called and spoke to Mrs. Castro and 04/15/25 LPA's Wesley and Trueman went to the facilty and asked the Licensee's have they issued the 30 day notice, or tried to locate facilities for the resident to reside and they answered no.the state’s words, verbatim · CDSS document, Apr 15, 2025

Plan of correction: The licensee is to remove the Resident from the facility ASAP, no later than 04/27/25, and give the resident their 30 day notice to vacate, or show proof that they have contacted facilities for the resident to move into by 04/15/25.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Tyler Reyes and Luis Deleon conducted an unannounced Required 1 year inspection at the facility and met with Administrator Mona Castro and explained the purpose for todays visit. The facility consist of 3 bedrooms,1 bathrooms, living room, dining room, kitchen, front and back yard with shaded area and attached garage used for storage and laundry services. The facility had all postings at the front entrance, bathroom, and throughout the facility. LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen. The water temperature was tested and measured at 111.5 degrees F. LPA received a copy of the facility liability insurance. LPA observed upon record review of medication resident #1 (R1) was missing Cough Syrup Liquid PRN (Take Five (5) ML By Oral Route Every 4 hours as Needed). Administrator Castro was unable to locate missing medication and stated a caregiver possibly disposed of medication. Administrators certificate for Mona Sheila B Castro expires 09/01/2025 The Facility administrator was provided a copy of this licensing report along with appeal rights(LIC 9058), during the exit interview.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced Required 1 year inspection at the facility and met with Administrator Mona Castro and explained the purpose for todays visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Plan in place. Operational Requirements The facility is approved for AGE RANGE 60 AND OVER. APPROVED FOR 6 NON-AMBULATORY. HOSPICE WAIVER FOR 2 RESIDENTS. A Certificate of Liability Insurance was observed and a copy was obtained. Due to time constraints, LPA will return at a later date to complete all (12) CARE Tool domains. Exit interview conducted with Administrator Mona Shelia Castro and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Administrator Mona Castro and explained the purpose for todays visit. The facility phone number is 562 404 7010. The facility consist of 3 bedrooms,1 bathrooms, living room, dining room, kitchen, front and back yard with shaded are and attached garage used for storage and laundry services. There was a conversion that took place at the facility that the licensee did not inform CCLD about: 1 staff room(restroom inside) was converted to 2 bedrooms, and 1 bathroom. This is still pending a possible citation/management approval. The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies was observed upon entry into the facility. LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen. The water temperature was tested and measured at 105.3 degrees F. LPA Wesley received a copy of the facility infection control plan at the time of visit. Administrators certificate for Mona Sheila B Castro 6045533740 expired on 08/31/2023. Administrator has proof of mailing, that she submitted the documents and we visited the website to make sure everything was received.the state’s words, verbatim · CDSS document, Dec 18, 2023