Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Caregiver/Administrator Andres Villaluz. Licensee/Administrator Danilo Sy arrived during visit.

This facility has a fire clearance for four non-ambulatory. There are three resident rooms: two private and one shared. The shared resident room has a private full bathroom. All three resident rooms have an exit to the outside. There is one full common bathroom. There is one staff room. The backyard has a covered area.

The following was observed during today's visit:

-facility meets the seven day non-perishable and two day perishable food supply.

-two of three resident records were reviewed

-the backyard has furniture and two appliances that Caregiver stated is going to be picked up soon. The furniture and appliances are stacked and placed in ways that do not impede any walkways in the back nor do they pose a hazard. LPA was informed the items are being picked up this Friday.

The following shall be updated and submitted to Community Care Licensing Division by April 19, 2024:

-a copy of the current liability insurance

-LIC 308 designation of administrative responsibility

-LIC 500 personnel report or staff schedule