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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607854
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:31:20 PM

Document Has Been Signed on 02/27/2025 12:31 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:IMPERIAL CAREFACILITY NUMBER:
197607854
ADMINISTRATOR/
DIRECTOR:
IRENE B. IMPERIALFACILITY TYPE:
740
ADDRESS:18423 NORAN AVENUETELEPHONE:
(562) 402-4444
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 6CENSUS: 6DATE:
02/27/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Irene Imperial, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA met with Administrator, Irene Imperial, and explained the reason. The initial inspection began on 2/21/25.

During the visit today, LPA inspected the remaining domains of the CARE tools. The following were reviewed:
Staffing: Per the administrator, there is sufficient staffing to meet the needs of the residents.
Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed (3) staff files including the Administrator. Staff employed are over the age of 18 and have criminal background clearance and associated to the facility. They are receiving on-going training. Administrator certificate expires on 3/6/26.
Resident Rights-Information: The local ombudsman poster, complaint poster, and Resident rights are posted in a prominent area. Facility provides internet service.
Resident Records-Incident Reports: LPA reviewed (6) resident files. The files contain the Admission Agreement, Physician's Report (including TB and Ambulatory Status), Consent forms, Personal Property and Valuable form, and current Appraisal/Needs and Services plan.
Health Related Services: Medications are centrally stored and locked. LPA reviewed medication for 6 residents and documentation. They are administered as prescribed by the physician.
Disaster Preparedness: The facility has a complete Emergency Disaster plan. LPA issued a technical advisory on the emergency disaster drill.

No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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