Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for ambulatory residents. There are four private resident rooms. One resident room has a full private bathroom. There is one full common bathroom. Common areas, resident rooms, and office were toured and no hazards observed. There is a locked cabinet for medications. The perishable and nonperishable food supply meets regulations. The backyard was inspected. There is a locked shed in the backyard.

Four resident files and three staff files were reviewed.

The following shall be updated and submitted to Community Care Licensing Division by May 3, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule

-Articles of Incorporation or Organization, Constitutional and Bylaws

The annual fees are due by April 16th of every year. As of April 12, 2024, the annual fees were not yet paid.