Facility Evaluation Report

LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed staff wearing the mask.

This facility has a fire clearance for two non-ambulatory and four ambulatory residents for a total of six. The main entrance opens to the main sitting room and dining room. The kitchen to the right of the dining area. There is a hallway on the right of the main entrance that leads to three resident rooms, the laundry closest, full bathroom, and the door leading to the garage. The largest room has a full private bathroom.. There is a second hallway that is past the dining area that leads to the staff area, and two resident rooms. There is a door leading the backyard from that hallway. The backyard was inspected. There is a gate on the same side as the garage.

LPA reviewed on resident file and one staff file.

The following shall be updated and submitted to Community Care Licensing Division by December 17, 2022:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibilities