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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004112
Report Date: 01/06/2025
Date Signed: 01/06/2025 11:12:11 AM

Document Has Been Signed on 01/06/2025 11:12 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VERONA COURT XFACILITY NUMBER:
306004112
ADMINISTRATOR/
DIRECTOR:
JULIE GORORDOFACILITY TYPE:
740
ADDRESS:25691 SABINA AVENUETELEPHONE:
(949) 916-2699
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Arda KardrjianTIME VISIT/
INSPECTION COMPLETED:
11:44 AM
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Licensing Program Analyst (LPA) Samer Haddadin made an unannounced required annual inspection at this facility. LPA was greeted and granted entry and met with Administrator (AD) Arda Kardjian and stated the purpose of this visit.


This is a single story facility comprised of six resident bedrooms and two resident bathrooms, two staff bedrooms, 1 staff bathroom with a laundry room, 2-car garage, living room and a dining room . The facility is licensed for six non-ambulatory with a hospice waiver for six. This facility is a Residential Care Facility for the Elderly.

LPAs toured the interior and exterior portions of the facility. There were four residents in care at the time of the visit.

Resident rooms were provided with furniture, chair and clean Lenin adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured between 115.5- and 117.7-degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements.

Fire extinguisher was observed with last inspection date of 12/5/2024. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards and ample space for activities. facility has 2-car garage and is kept locked and used for storage. Laundry room was equipped with an operational washer and dryer.

Kitchen was in good repair with cleaning supplies and sharp items inaccessible to residents in care. Medications are kept locked separately in living room closet. LPAs reviewed two clients’ files and medications with no discrepancies observed. LPAs reviewed two staff files with no discrepancies noted

Alisa OrtizTELEPHONE: (714) 703-2855
Samer HaddadinTELEPHONE: (714) 790-2096
DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 X
FACILITY NUMBER: 306004112
VISIT DATE: 01/06/2025
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. All files of staff and clients contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted on 12/10/2024. LPAs also checked The administrator certificate which is valid and expires on September 19th, 2025
.Based on the observations, no deficiency is being cited as per the Title 22 Division 6 Chapter 8 of the California Code of Regulations.

An exit interview was conducted with Administrator Arda Kardjian, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Samer HaddadinTELEPHONE: (714) 790-2096
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
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