Facility Evaluation Report

LPA Hiratsuka conducted this announced prelicensing visit. LPA met with Applicant Azucena Agati and Facility Representative Mae Katz.

This facility has a fire clearance for three ambulatory and one non-ambulatory residents. This facility has four private resident rooms and no staff room. The facility is required to have 24 hour awake staff. The main entrance opens to a hallway. There are two private resident rooms and a full common bathroom to the left of the main entrance. On the right there is a door leading to the garage. On the right of the facility has a second hallway that has two private resident rooms and both have full private bathrooms. One room has a door to the outside. The back of the facility is where the kitchen, dining, and sitting areas are located. There is a sliding door to the outside. The gate is located on the same side as the garage. On the side opposite the garage there is a shed.

Component III orientation was waived because Applicant owns other facilities.

This facility meets regulations. LPA is going to submit this report to the application specialist.