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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005671
Report Date: 03/28/2023
Date Signed: 07/07/2023 11:01:40 AM

Document Has Been Signed on 07/07/2023 11:01 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 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: DATE:
03/28/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Arda KardjianTIME COMPLETED:
12:00 PM
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On 03/28/2023, Licensing Program Manager (LPM) Armando Lucero and Licensing Program Analyst (LPA) Lydia Martinez conducted a virtual Informal Meeting via Microsoft Teams with Licensee/Administrator Arda Kardjian.

The purpose of this Informal Meeting was to discuss transition of facility types.

The following items were discussed with Current and Prospective Licensees:

· Change of facility type from a Residential Care Facility for the Elderly (RCFE) to a Congregate Living Health Facility (CLHF).
· Licensee to notify the residents and their responsible parties as per 87109(c)
· Develop a relocation plan that needs to be approved by the Department.

Licensee acknowledged understanding of the process to transition the facility to the new license.

An exit interview was conducted and a copy of this report was provided to Licensee via email for signature.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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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