Facility Evaluation Report

LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing masks. LPA toured the facility with Caregiver Xavier Maneewong.

This facility has three private resident rooms. There is one full common bathroom and one full bathroom in a private room. The private room with the bathroom has an exit to the outside. There is no staff room. The garage is connected to the house through a door between the garage and common area. The kitchen was inspected. There is a dining nook in the kitchen. There is a gate on the same side as the garage. The common areas are well maintained.

-one of three resident files were reviewed

-a couple of topics were discussed with Caregiver.

The following shall be updated and submitted to licensing within 30 days;

LIC 500- facility personnel or staff schedule

LIC 308- designation of administrative responsibility