Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Caregiver Rowena De Vera.

This facility has a fire clearance for six non-ambulatory residents. There is one shared resident room that has a full private bathroom and four private resident rooms. There is one staff room. Backyard was inspected and there is a locked shed in the backyard. LPA reviewed three staff files and three resident files. Common areas and resident rooms were inspected.

The following was observed during today's visit:

-one resident's bed who is not on hospice has full bed rails. Title 22 regulations does not allow full bed rails on a bed unless the resident is on hospice.

-Title 22 regulations requires annual training in multiple subjects. One caregiver has the initial training in 2022, but no training logs other than catheter training in 2023.

-Title 22 regulations requires current first aid for all caregivers on duty. One caregiver's first aid was issued on 07/29/2017. No other card was found since then.

-One caregiver's training was last completed on 04/15/2023. The annual training has not yet been completed for this month.

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

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal rights were provided.