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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002554
Report Date: 12/09/2024
Date Signed: 12/09/2024 01:42:50 PM

Document Has Been Signed on 12/09/2024 01:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VERONA COURT IVFACILITY NUMBER:
306002554
ADMINISTRATOR/
DIRECTOR:		ARDA KARDJIANFACILITY TYPE:
740
ADDRESS:23961 STILLWATER LANETELEPHONE:
(949) 249-9047
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Tarek El NabliTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Licensee Tarek El Nabli and explained the reason for the visit. The facility is a single story house with 7 bedrooms, 2 bathrooms, kitchen, living room, dining room and a two car garage. The facility has no residents or staff at this time. The Licensee reported that the house is being renovated. LPA toured the facility and verified there are no residents or staff at the facility. LPA observed no personal belongings in the facility. LPA informed the Licensee to notify the LPA if residents move in or if the facility closes. Licensee stated he understood. LPA observed the facility has utilities and water service. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
Sheila SantosTELEPHONE: (714) 334-2062
Joseph AlejandreTELEPHONE: 714-705-6018
DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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