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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004112
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:53:35 PM


Document Has Been Signed on 02/22/2024 03:53 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 XFACILITY NUMBER:
306004112
ADMINISTRATOR:JULIE GORORDOFACILITY TYPE:
740
ADDRESS:25691 SABINA AVENUETELEPHONE:
(949) 916-2699
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 4DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Arda Kardjian- AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to conduct the Required 1-Year Annual Inspection. LPA was greeted and granted entry after stating the purpose of the visit to Caregiver Maila Salvador. Administrator (Admin) Arda Kardjian arrived shortly after to assist with the inspection.

LPA conducted a tour of the physical plant with the Admin, and the following were observed: 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 dining room. LPA toured the outside grounds. There was shading and sufficient seating for the residents. The exit gate was self-closing and self-latching.
LPA observed four residents and two caregivers on duty. The resident bedrooms are spacious and can easily accommodate the residents' furnishings. Furniture for each resident bedrooms were inspected. The bathrooms were clean, faucets, toilets, and grab bars were operational. Showers were free of mold/mildew, and a non-skid surface mat was in place. The hot water temperature measured at 116.7 and 118.9 degrees Fahrenheit in the resident bathrooms. There were sufficient supply of clean linens. LPA observed a two-day supply of perishables and a seven-day supply of non-perishable food as required per regulation. Carbon monoxide, smoke detectors, and the auditory devices were tested and operational. The fire extinguisher was serviced on 12/15/23. Medications, sharps, and toxins were locked and inaccessible to the residents. Facility had ample supply of emergency supplies including food/water and first aid kit. LPA observed the Complaint Poster (PUB 475) in the required size of 20" x 26."LPA reviewed four out of the four resident files including the medications and two out of the two staff files during today's visit.

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: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
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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