Facility Evaluation Report

Licensing Program Analyst (LPA) Karina Canela conducted a pre-licensing inspection on 05/05/2023 at Imagine at Union. LPA met with applicant Virginia Punzalan, who will be the Administrator once the facility is approved for licensure. Patricia and Jerome Bucal were also present. The facility has a fire clearance approval from the city of Fairfield Fire Department for a total of 4 ambulatory only residents. The facility does not have approval to accept or retain non-ambulatory or bedridden residents. Facility will operate with 24 hour staffing and Licensee will ensure sufficient staffing at all times.

During today’s visit LPA observed the following items:

· Lockable separate cabinets for medication, toxins, and knives.

· 7 smoke detectors and 1 carbon monoxide detector were tested and observed operational

· First Aid kit, night-light, and flashlights for emergency lighting

· Supply of linens, paper products, and hygiene supplies available

· Fire Extinguisher charged and serviced 01/11/2023

· Required furnishings in 4 of 4 bedrooms

· Administrator Certification; Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Client personal rights and visitor policy).

· The water temperature was tested during inspection and was within regulation of 105-120 Degrees F.

Pre-licensing is complete and this facility has no corrections needed.

The Component III Orientation was completed. LPA will submit the pre-licensing application report to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.