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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005670
Report Date: 11/23/2022
Date Signed: 11/23/2022 12:22:15 PM

Document Has Been Signed on 11/23/2022 12:22 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 XIIFACILITY NUMBER:
306005670
ADMINISTRATOR:ARDA KARDJIAN RN,BSNFACILITY TYPE:
740
ADDRESS:23852 WARDLOW CIRCLETELEPHONE:
(949) 230-3797
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 4DATE:
11/23/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Julie Sanders, Arda KardjianTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the Post Licensing visit, LPA was greeted and granted entry by staff. .LPA met with Administrator Arda Kardjian and assistant administrator Julie Sanders. LPA explained the reason for the visit. Facility is a single story home with 6 bedrooms (1 bedroom is for caregivers and one of the resident rooms is a shared room), 3 bathrooms, dining room, living room and attached 2 car garage that is being used for storage and kept locked. LPA and assistant administrator toured the facility. LPA observed the See Something Say Something Poster (PUB 475) posted next to the front door of the facility. LPA observed the fireplace in the living room is screened. LPA observed all resident bedrooms had the required furnishings and are clean and organized. LPA observed all 3 bathrooms are clean and operational. Hot water measured 109.2 degrees Fahrenheit. LPA inspected the kitchen. The kitchen is clean and organized. LPA observed the knives are kept locked in a kitchen drawer. LPA observed the medications are kept locked in a kitchen cabinet. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA toured the garage. The garage has doorknob with a numeric keypad lock to keep it secure. The garage is used to store extra food and supplies. LPA and assistant administrator toured the backyard. There is one exit gate on the East side of the house. The exit is operational. No bodies of water observed. There are 2 separate seating areas in the patio. No obstacles or hazards observed in the backyard. LPA inspected the first aid kit. The first aid kit has all the required items. 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.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
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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