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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006243
Report Date: 01/09/2025
Date Signed: 01/09/2025 04:05:54 PM

Document Has Been Signed on 01/09/2025 04:05 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 XIVFACILITY NUMBER:
306006243
ADMINISTRATOR/
DIRECTOR:		KARDJIAN, ARDAFACILITY TYPE:
740
ADDRESS:23952 HILLHURST DR.TELEPHONE:
(949) 230-3797
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 4DATE:
01/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Arda KardijianTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Brandon Lopez made an announced visit to conduct the required annual inspection. LPAs were greeted and granted entry by caregiving staff after explaining the purpose for today's visit. Administrators (ADs) Arda Kardijian and Julie Gorordo were notified via telephone and later arrived to assist with the inspection. LPAs observed that Administrator Arda Kardijian has a valid Administrator certificate which expires on September 19, 2025. The facility is a Resident Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility is a one story home with six residents bedrooms, one staff room, six bathrooms, a living room, a kitchen, a dining room, and an attached two car garage. LPAs accompanied by the ADs conducted a tour of the physical plant. On today's visit, LPAs observed four residents in care and three caregiving staff present. LPAs observed the See Something Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPAs inspected all six residents bedrooms. All resident bedrooms has the required furnishings of a bed, a chest of drawers, a chair, and a lamp. Resident bedrooms were clean and spacious. LPAs inspected resident bathrooms. Resident bathrooms were equipped with grab bars and non-slip mats. Faucets and toilets were operational. Hot water temperature measured between 108.5 and 112.4 degrees Fahrenheit. LPAs observed additional linens stored in a hallway closet. LPAs observed the facility has a two day perishable and seven day non-perishable food supply on hand. LPAs observed the five burner gas stove lights unassisted. LPAs observed knives stored in a locked kitchen cabinet. LPAs observed chemicals stored under the kitchen sink in a locked cabinet. LPAs observed a fire extinguisher mounted on the wall in the kitchen. The fire extinguisher is charged and services as of December 20, 2024. LPAs tested the dual smoke/carbon monoxide detectors which tested operational. LPAs observed the facility conducted their last emergency disaster drill on December 10, 2024. The centrally stored medication is stored in a locked cabinet in the dining room. LPAs observed the First Aid kit has all the required components. CONTINUED ON 809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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 XIV
FACILITY NUMBER: 306006243
VISIT DATE: 01/09/2025
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The door leading to the attached garage is kept locked and inaccessible to residents. The garage is used for laundry and storage. LPAs observed the facility has an emergency three day food and water supply stored in the garage. LPAs and ADs toured the exterior portion of the facility and observed it to be free of obstructions and hazards. LPAs observed a shaded seating area with furniture for resident use. The perimeter gates on the Northside and Southside of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPAs reviewed all four resident records. No discrepancies observed. LPAs reviewed all four resident medication and medication records. No discrepancies observed. LPAs reviewed all three staff records. All staff are background cleared and associated to the facility. The facility has an internet device that is dedicated for resident use. Based on the observations made during today's visit no deficiencies are being cited. An exit interview was conducted with Administrators Arda Kardijian and Julie Gorordo. A copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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