Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Administrator Cecilia Ganzon.

This facility has a fire clearance for five non-ambulatory residents. There are three private and one shared resident rooms. Three resident rooms have exits to the outside. There is one shower that is between two half bathrooms. LPA toured the common areas and resident rooms. There is an ample supply of perishable and nonperishable food. There is a locked cabinet for medications and confidential folders.

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

-plan for incidental and medical care for residents

LPA reviewed two resident records and the staff records.