Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Caregiver Melody Mwakalombe. There was one resident present during the visit.

This facility has a fire clearance for three ambulatory and one non-ambulatory residents. The facility has four private resident rooms; two full common bathrooms and the largest room has a full private bathroom; laundry room; two common areas; dining and kitchen. There is a door leading to the garage from the facility. There are locked cabinets for medications and records. LPA reviewed four resident and four staff files.

The following shall be updated and submitted to Community Care Licensing Division by September 15, 2023:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility