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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804132
Report Date: 09/11/2024
Date Signed: 09/11/2024 04:15:29 PM

Document Has Been Signed on 09/11/2024 04:15 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:IMAGINE AT UNIONFACILITY NUMBER:
486804132
ADMINISTRATOR/
DIRECTOR:		PUNZALAN, VIRGINAFACILITY TYPE:
735
ADDRESS:830 UNION AVETELEPHONE:
(818) 642-3943
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
09/11/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Virginia Punzalan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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At approximately 3:30 PM, Licensing Program Analyst (LPA) Julie Florio met with Licensee, Virginia Punzalan at Red Jade Home where she works. LPA was there completing a required 1-year annual inspection and followed that visit with this interview to follow up on numerous IRs received by CCL since May 2024 regarding an Imagine at Union Client 1 (C1).

LPA conducted an interview with Licensee to get an update regarding this ongoing situation. (See LIC812)

No deficiencies cited during today's visit. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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