Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Administrator Angelita Mamsaang.

This facility has a fire clearance for six ambulatory residents. This facility has six resident rooms. The largest resident room has a full private bathroom. There are two full common bathrooms. Two bedrooms share one full bathroom. There is a laundry room. The backyard has a shed. There is a locked closet for medications. Common areas and resident rooms were toured.

LPA reviewed three resident files and one staff file.

Licensee inquired about what is required if a resident wishes to be left alone at the facility without staff. LPA stated the client has to be deemed able to be left alone by themselves by a planning team that includes responsible party and doctor. If the planning team deems the resident able to be left alone at the facility without staff then the licensee shall submit to Community Care Licensing for an exception for the resident.

The following shall be updated and submitted to Community Care Licensing Division by May 1, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule