Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. LPA met with Administrator Azucena Agati and Co-Administrator 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.

LPA reviewed staff training and reviewed two resident records. LPA also reviewed the medication administration records.

The following shall be updated and submitted to Community Care Licensing Division by August 10, 2024:

LIC 500 facility personnel or staff schedule

LIC 308 designation of administrative responsibility.