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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003433
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:38:08 PM


Document Has Been Signed on 02/01/2024 03:38 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:VERONA COURT VIFACILITY NUMBER:
306003433
ADMINISTRATOR:TAREK EL NABLIFACILITY TYPE:
740
ADDRESS:24141 ROMA DRIVETELEPHONE:
(949) 916-6259
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
02/01/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jeff Gardner - AdministratorTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived to conduct an unannounced closure visit. Upon arrival LPA observed the garage door to be open and the walls within the garage to have been torn down. LPA observed pieces of the torn-down wall on the floor in the garage as well as exposed pipes. A flat bed trailer was also in front of the house with debris that looked similar to the debris in the garage. LPA observed two people working on tearing down the garage. LPA approached, introduced self and explained the nature of the inspection. One of the individuals, Robert, stated that the owner was not present but called. LPA spoke to the Owner, Jeff, on the phone and re-stated the purpose of the inspection. The owner gave verbal permission to the LPA to enter the home. LPA observed the home to be absent on furniture in all bedrooms. LPA observed the walls to have been torn down in multiple rooms. LPA observed the pool to be empty. The facility was absent of decorations, leisure furniture/appliances and personal belongings.

Based on observations, LPA determined the facility is not operating and there are no clients in care. LPA reviewed this report with the owner over the phone and provided this report to the owner via email.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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