Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Caregiver Maria Duenas.

This facility currently five residents. This facility has a fire clearance for six non-ambulatory residents. There are four private resident rooms and one shared resident room. The shared resident room has a full private bathroom. One of the private rooms has a private bathroom. There is one full common bathroom. There are several common areas. Food supply meets regulations. There is a detached garage that has an employee/office area in it. The backyard has a wood deck and a ramp.

The following deficiencies were observed today:

-the annual fees have not been paid for a couple of years. The total amount due as of today is $1,237.00.

-the staff records reviewed showed the most recent training was November 2022. All past training records show November as the month for training. LPA did not find any training for 2023.

The following shall be updated and submitted to Community Care Licensing Division (CCLD) by January 26, 2024:

-updated control of property. The lease agreement on file in the CCLD office shows the lease expired in January 2022

-LIC 500 facility personnel or staff schedule

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left