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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005671
Report Date: 11/23/2022
Date Signed: 11/23/2022 02:06:31 PM


Document Has Been Signed on 11/23/2022 02:06 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:VERONA COURT XIIIFACILITY NUMBER:
306005671
ADMINISTRATOR:ARDA KARDJIAN RN, BSNFACILITY TYPE:
740
ADDRESS:23851 WARDLOW CIRCLETELEPHONE:
(949) 230-3797
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 5DATE:
11/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Arda KardjianTIME COMPLETED:
02:33 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Arda Kardjian. Assistant administrator Julie Sanders was also present. Facility is a two story home. The fist floor consists of 6 bedrooms, living room, kitchen, dining room, 7 bathrooms and a 2 car garage. The second floor is for staff only and has one bedroom and one bathroom. LPA and Administrator toured the facility. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen cabinet. LPA observed medications are kept locked in a cabinet. LPA observed the stove lights unassisted. The fire extinguisher in the kitchen is fully charged. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all resident rooms had the required furnishings. Each room has enough space to accommodate the resident and their belongings. LPA observed all resident bathrooms are clean and operational. Hot water measured 105.8 degrees Fahrenheit. LPA and Administrator toured the garage. The garage is inaccessible to residents and used for storage. LPA and Administrator toured the back yard. No bodies of water observed. There is a covered patio with seating for residents to sit outside. Both exit gates are operational. No obstacles or hazards observed. No deficiencies observed during the visit. 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: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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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