Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit.

This facility has a fire clearance for three ambulatory and one non-ambulatory residents. This facility has four private resident rooms and one staff room. The staff room has a full private bathroom. There is one full common bathroom. There is a common area, kitchen, and office area. There is a laundry room and a door that connects to the garage. The garage is used for storage. The facility has an ample supply of perishable and nonperishable food. There are locked cabinets for medications and cleaning toxins. The backyard is well maintained.

Four resident files were reviewed and staff training was reviewed.

The following shall be updated and submitted to Community Care Licensing Division by May 20, 2024:

-LIC 308 designation of administrative responsibility

-LIC 500 facility personnel or staff schedule