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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850058
Report Date: 07/30/2021
Date Signed: 07/30/2021 02:56:11 PM

Document Has Been Signed on 07/30/2021 02:56 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:IMPRESSIVE CARE, INC.FACILITY NUMBER:
195850058
ADMINISTRATOR:TAGARYAN, ARMINE ADRINEFACILITY TYPE:
740
ADDRESS:13302 ARMINTA STREETTELEPHONE:
(818) 517-6594
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 3DATE:
07/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Armine TagaryanTIME COMPLETED:
03:00 PM
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On 07/30/2021 at 1:00 pm, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility, introduced herself and explained the reason for the visit. LPA conducted an unannounced required annual inspection visit.

INFECTION CONTROL: Upon entry, the facility has a sign in book, thermometer to take temperature and sanitizing gel. Infection Control signage was visible at entrance.

At 1:10pm LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Kitchen: 1:15pm LPA observed the kitchen/dining area. Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for residents and staff. Medication cabinet is locked, and medication has a seven-day supply.

Bedrooms: At 1:30pm, LPA observed the residents’ bedrooms. Bedrooms were furnished appropriately, appropriate furnishings, clean linens and sufficient lighting.

Bathrooms: At 1:45pm, LPA observed the Residents’ restrooms. Restrooms were clean, shower area was in clean condition with grab bars and non-skid mat available. Paper towels were available for drying hands.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: IMPRESSIVE CARE, INC.
FACILITY NUMBER: 195850058
VISIT DATE: 07/30/2021
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Outdoor Space: At 2:00 pm, LPA observed the Outdoor space. A shaded patio is available for residents to visit with family members. Sliding door to patio area is activated by sound system when opened. Side gates are unlocked. Gate leading to outdoors is adapted with sound system to alert staff of any elopement. A pool in the backyard is fenced and had a gated lock door.

Facility Records: At 2:30pm, LPA reviewed staff and residents’ records. All flies are in good order, and meet licensing requirements.



At 2:45 pm, LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
LIC809 (FAS) - (06/04)
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