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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005671
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:02:14 PM

Document Has Been Signed on 12/12/2024 04:02 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 XIIIFACILITY NUMBER:
306005671
ADMINISTRATOR/
DIRECTOR:		ARDA KARDJIAN RN, BSNFACILITY TYPE:
740
ADDRESS:23851 WARDLOW CIRCLETELEPHONE:
(949) 230-3797
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Administrator Julie GorordoTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by caregiving staff after explaining the purpose for the visit. Administrator (AD) Julie Gorordo was notified via telephone and later arrived to assist with the inspection. LPAs observed Administrator Julie Gorordo has a valid administrator certificate which expires on July 17, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six nonambulatory residents and has a hospice waiver for six. The facility is a two story home with six resident bedrooms, one staff bedroom, eight bathrooms, a living room, a dining room, a kitchen, and a two car garage. The second story consists of a loft, one staff bedroom, and a staff bathroom. The second story of the facility is for staff use only and off limits to residents. LPAs, accompanied by the Administrator conducted a tour of the physical plant. On today's visit, LPAs observed four residents in care and two caregiving staff present. LPAs observed the See Something, Say Something poster (PUB 475) mounted on wall by the entryway of the facility. LPAs inspected all six resident bedrooms. All resident bedrooms had the required furnishings of a bed, a chest of drawers, a lamp, and a chair. Resident bedrooms are clean and spacious. LPAs observed the facility has ample supply of linens on hand which are stored in a hallway closet. LPAs inspected resident bathrooms. Bathrooms are clean. Toilets and faucets tested operational. Bathrooms are equipped with grab bars and non-skid floor mats. Hot water temperature measured between 113.7 and 118.9 degrees Fahrenheit. LPAs observed the facility has a minimum two day perishable and seven day nonperishable food supply on hand. Kitchen appliances were clean. LPAs observed the four burner gas stove lights unassisted. LPAs observed cleaning supplies locked in a kitchen cabinet under the sink. Knives are kept locked in a kitchen cabinet. LPAs observed a fire extinguisher mounted in the kitchen. Fire extinguisher is charged and up to date on service. LPAs observed the facility conducted their last emergency disaster drill on December 9, 2024. LPAs tested the dual smoke/carbon monoxide detectors which tested operational. The two car garage is used for storage and laundry. The garage has a cage which is kept locked and inaccessible to residents. LPAs observed the facility has a three day emergency food and water supply stored in the garage. Continued on LIC809-C
Sheila SantosTELEPHONE: (714) 334-2062
Joseph AlejandreTELEPHONE: 714-705-6018
DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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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 XIII
FACILITY NUMBER: 306005671
VISIT DATE: 12/12/2024
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LPAs, accompanied by the Administrator toured the exterior portion of the facility. There is a shaded seating area with furniture for resident use. LPAs observed the backyard to be free of hazards and obstructions. No bodies of water were observed on the premises. There are two exit gates on the premises which are operational and self latching. LPAs reviewed four resident files and three staff files. No discrepancies observed. LPAs reviewed four resident medications and medication records. No discrepancies observed. LPAs inspected the First Aid kit which has all the required components. Staff is background cleared and associated to the facility. LPAs observed the facility has an internet device that is dedicated for resident use. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Julie Gorordo and a copy of the report was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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