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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306002097
Report Date:
02/28/2022
Date Signed:
02/28/2022 02:46:20 PM
Document Has Been Signed on
02/28/2022 02:46 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
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
VERONA COURT
FACILITY NUMBER:
306002097
ADMINISTRATOR:
ARDA KARDJIAN
FACILITY TYPE:
740
ADDRESS:
29681 PRESTON DRIVE
TELEPHONE:
(949) 218-9920
CITY:
LAGUNA NIGUEL
STATE:
CA
ZIP CODE:
92677
CAPACITY:
6
CENSUS:
4
DATE:
02/28/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:25 PM
MET WITH:
Arda Kardjian
TIME COMPLETED:
03:02 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. Administrator Arda Kardjian arrived at 2:00 pm. Her Administrator's certificate expires on 9/18/2023. LPA explained the reason for the visit. LPA and staff toured the facility. The hot water measured 110.0 degrees Fahrenheit in bathroom one and 112.0 degrees Fahrenheit in bathroom 2. Both bathrooms are clean and operational. LPA and staff toured resident bedrooms. All resident rooms had the required furnishings and enough space to accommodate the residents and their belongings. First aid kit was inspected and has all the required elements. LPA and staff toured the kitchen and dining room. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. The kitchen is clean and organized. LPA and staff toured the backyard. There is a seating area outside for the residents. The one exit gate is operational. No bodies of water observed. No obstacles or hazards observed in the backyard. The garage is kept locked and used for storage. Smoke detectors/carbon monoxide detectors tested operational. Facility has a mitigation plan that has been approved. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME
:
Luz Adams
LICENSING EVALUATOR NAME
:
Joseph Alejandre
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/28/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/28/2022
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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