Facility Evaluation Report

LPA Hiratsuka conducted this annual visit.

This facility has a fire clearance for five ambulatory only residents. There is one shared resident and three private resident rooms. The shared resident room has a full private bathroom. There is one full common bathroom. There is an ample supply of nonperishable and perishable food. There is a locked shed in the backyard.

LPA reviewed one resident file and five staff files.

The following shall be updated and submitted to Community Care Licensing Division by April 16, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule