Facility Evaluation Report
Capacity4
Census4
Date signed04/15/2024 05:16:01 PM
LPA Hiratsuka conducted this unannounced annual visit. LPA toured with House Manager Patricia Bucal.
This facility has a fire clearance for one non-ambulatory and three ambulatory residents. Areas toured were resident rooms and common areas. One resident room has a full private bathroom. No health and safety issues were observed. The backyard has a locked shed. Two staff and two resident records were reviewed.
The following shall be updated and submitted to CCLD by April 30, 2024:
-LIC 308 Designation of Administrative Responsibility
-LIC 500 facility personnel or staff schedule
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction