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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004113
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:19:47 PM


Document Has Been Signed on 10/17/2024 03:19 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 IXFACILITY NUMBER:
306004113
ADMINISTRATOR:ARDA KARDJIANFACILITY TYPE:
740
ADDRESS:29842 ANDREA WAYTELEPHONE:
(949) 545-6698
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 0DATE:
10/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Julie GorordoTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA observed the facility was empty and no one was inside. LPA knocked on the door and there was no response. LPA called the Administrator and the Administrator reported the facility was empty. The Administrator had the Assistant Administrator, Julie Gorordo, meet the LPA at the facility. LPA met with the Assistant Administrator who granted access to the facility. LPA observed the facility is empty except for a dining room table and chairs. LPA verified the facility has no residents. The Assistant Administrator reported the facility is being remodeled. LPA did not observe any personal belongings in the facility. The facility has 5 bedrooms and 1 caregiver room. LPA observed the facility has electricity, water and gas. The dishwasher, refrigerator and stove are all operational. No files were reviewed because there are no staff members or residents. LPA consulted with the Assistant Administrator concerning reporting requirements. LPA and the Assistant Administrator toured the facility. No obstacles or hazards observed in the facility. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024
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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