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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804170
Report Date: 10/30/2023
Date Signed: 10/30/2023 05:57:18 PM

Document Has Been Signed on 10/30/2023 05:57 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:UCPNB SENIOR ADULT PROGRAMFACILITY NUMBER:
496804170
ADMINISTRATOR:CORRADI, GERALDFACILITY TYPE:
775
ADDRESS:6597 COMMERCE BLVDTELEPHONE:
(707) 766-9990
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 45CENSUS: DATE:
10/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Jennifer Whalen-Program DirectorTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Alviso, conducted a prelicensing inspection, on 10/30/23 at approximately 4:00pm, and met with Director Jen Whalen. This application is a change of location to a new Rohnert Park location. Component III Orientation was completed with Jennifer Whalen Program Director, and Danielle Schulze, Program Manager.

Fire clearance is approved for forty-five (45) ambulatory. Fire extinguishers are tagged and serviced as required. Fire alarm system are smoke alarms, which also check for carbon monoxide.

The location site was observed to be clean and orderly. All rooms are being set up, and all items are stored out of the way, ensuring all walkways and exits are clear as required. There is a quiet room for client use as needed. There are two restrooms, one has two stalls and a urinal, and the other has three stalls. Hot water was checked at 108.degrees Farenheit. The facility site has sufficient lighting in all rooms, common areas, and bathrooms. Bathrooms have paper towels, and soap; The kitchen area has soap and paper towels. All rooms, areas, and walkways are clear for client, staff and visitors to use safely. There are activity supplies and an activity crafts room, and large recreation room.

The LPA didn't observe any health and safety hazards during today's inspection,10/30/23.. The LPA will forward a copy of the pre-licensing inspection to the Application Unit Analyst; The Application Unit Analyst will contact the applicant with the status of the application.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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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