Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for six ambulatory residents. There are currently only two residents. This facility has four resident rooms. There is a locked shed in the backyard. There is an ample supply of perishable and nonperishable food. The common areas and resident rooms were inspected. LPA reviewed two resident files and the staff files.

The following shall be updated and submitted to Community Care Licensing Division by May 2, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule