Facility Evaluation Report
Capacity6
Census6
Date signed04/15/2024 01:39:20 PM
LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Administrator Annalee Gomez.
This facility has a fire clearance for three non-ambulatory and three bedridden residents. There are six private resident rooms. There are several common areas. This facility has a hospice waiver for two. There is an ample supply of perishable and nonperishable food.
The following shall be updated and submitted to Community Care Licensing Division by April 30, 2024:
-LIC 500 facility personnel or staff schedule
-LIC 308 designation of administrative responsibility
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction