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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004799
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:19:58 AM

Document Has Been Signed on 01/22/2025 11:19 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:VERDI HOMEFACILITY NUMBER:
306004799
ADMINISTRATOR/
DIRECTOR:		CRISTINA SANTOSFACILITY TYPE:
735
ADDRESS:6471 VERDI DRIVETELEPHONE:
(714) 994-6471
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 6CENSUS: 6DATE:
01/22/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:27 AM
MET WITH:Jessie NazarenoTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On January 22nd, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to continue the annual inspection began on January 21st, 2025. Upon arrival LPA Vanegas was greeted and granted entry by Direct Support Staff (DSP) Jessie Nazareno. LPA Vanegas explained purpose of the visit and began to continue the annual inspection and observed the following.

LPA Vanegas observed fire extinguisher to be fully charged and up to date. LPA Vanegas observed smoke detectors and carbon monoxide detectors to be fully functional. LPA Vanegas observed bathrooms to be clean and free of mildew and debris. Water temperature tested at 118-119.4 degrees. Restrooms had functional grab bars and slip resistant matts.

LPA Vanegas observed client rooms to not have a chair or lamp as required and a technical violation was issued on today's date. Client rooms had all other required furnishings such as a chest of drawers, a bed, and clean linens in good repair meaning no strains or tears.

LPA Vanegas reviewed two staff files and six resident files all staff files had the correct forms documented and up to date. However two out of six client files were missing a physicians report and a T.B Test result a technical violation was issued on today's date.

LPA Vanegas reviewed P&I with Asistant Administrator Martha Losoya and observed the following. All balances add up to the documented balance and per LPA review P&I is being accounted for correctly. LPA Vanegas reviewed medications with DSP Jessie Nazareno and per LPA review medications are being administered per physicians orders. Based on the observations made during today’s inspection, deficiencies are not being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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