Facility Evaluation Report

LPA Hiratsuka, conducted this unannounced annual visit. LPA toured with Co-Administrator Alena Polyakova and Anna Polyakova arrived during the visit. This facility has a fire clearance for six non-ambulatory residents. The main entrance opens to a sitting area. There is a private resident room with a full private bathroom and an exit to the outside on the immediate left of the main entrance. There is a hallway on the right side leading to three private resident rooms, one shared resident room, locked laundry room that leads to the garage, and one full common bathroom. The shared resident room has an exit to the outside and a full private bathroom. The medications, resident, and staff files are going to be locked in cabinets in the hallway. Past the first sitting area leads to the second sitting, dining, and kitchen area. The backyard has locked shed and there is a gate on the same side as the garage. The garage is going to be used for storage.

The following shall be updated and submitted to Community Care Licensing by 09/25/2023:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility