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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607854
Report Date: 02/21/2025
Date Signed: 02/21/2025 06:15:01 PM

Document Has Been Signed on 02/21/2025 06:15 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
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: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:06 PM
MET WITH:Irene Imperial, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection. LPA met with Administrator, Irene Imperial, and explained the reason for the visit. The facility is licensed for 6 residents, ages 60 and over, of which 5 may be non-ambulatory and 1 bedridden.

LPA used the Compliance and Regulatory Enforcement (CARE) tools and the following domains were inspected:
Infection Control: Facility has the infection control plan and staff are continuing to follow the plan. Staff are using gloves while assisting residents with their ADLs.
Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility. There are 2 residents on hospice. The facility has the sufficient amount for liability insurance covering injury to residents and guests.
Physical Plant & Environment Safety: The facility does not have a swimming pool on the premises. There are 3 shared resident bedrooms, 1 staff room, 2 bathrooms (1 communal and 1 in bedroom #4), living room, dining room, kitchen, and a garage. Facility has operable smoke detectors throughout the facility and a carbon monoxide detector located in the hallway. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F.
Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable. The foods are properly stored in the refrigerator.
Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. There are no residents with a restricted or prohibited health condition at this time.

LPA will return another day to continue the inspection. No deficiencies were observed today. An exit interview was held and a copy of this report was given to the administrator.
Tony VasalloTELEPHONE: (323) 981-3977
Cynthia D ChanTELEPHONE: (323) 981-3370
DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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