Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for five ambulatory residents. There are three resident rooms. There is one resident room that has a full private bathroom and one full common bathroom. There is one staff room. All common areas and resident rooms were inspected. No issues were observed.

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

-plan for Incidental Medical and Dental Care