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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004016
Report Date: 02/08/2022
Date Signed: 02/08/2022 11:57:42 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/08/2022 11:57 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VERONA COURT VIIIFACILITY NUMBER:
306004016
ADMINISTRATOR:A KARDJIANFACILITY TYPE:
740
ADDRESS:26712 EL MAR DRIVETELEPHONE:
(949) 916-8974
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Arda KardjianTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing a required inspection. LPA arrived at the facility there was no answer at the door. LPA contacted Administrator Julie Gorordo and was informed facility had no residents. Arda Kardjian, Administrator arrived shortly after. LPA observed there are no residents in care at the facility. Administrator informed LPA Barrett in March of 2021 that facility was going to relocate residents to one of the their facilities due to facility needing repairs. Licensee will contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license.

At this time there were no deficiencies to report in the facility. As noted above, Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following:

- An updated Personnel Report (LIC 500).

This report was reviewed with administrator and a copy of this LIC809 report was provided

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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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