Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit.

LPA toured the facility with Program Assistant Shelita Majied. This facility has a fire clearance for three non-ambulatory and two ambulatory residents. There are currently two residents who were at their day programs during this visit. There are five private resident rooms and two full common bathrooms. There is a separate office building and another building that may be used by the residents.

One of two resident files were reviewed and six staff training records were reviewed.

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

-LIC 500- facility personnel or staff schedule

-LIC 308 designation of administrative responsibility