Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. Administrator Lopez and Licensee Bal, arrived during visit. Three caregivers were on duty when LPA arrived.

This facility has a fire clearance for three ambulatory and one non-ambulatory residents. The main entrance opens to a sitting area and small office area to the left. To the right is a wall that has a door leading to the garage and a closet that is going to be locked. Past the sitting area in the back is the common area and the kitchen on the right. There is a locked cabinet for medications in the kitchen. On left side of the common area is the staff room that has a full private bathroom. To the right of the kitchen is a hallway leading to the four private resident rooms. There is one full common bathroom. There is one full bathroom that is shared by two resident rooms. There is a sliding door leading to the backyard from the back common room. There is a shed in the backyard. There is a gate on the same side as the garage. The garage is going to be used for storage.

The following shall be updated and submitted to Community Care Licensing by 10/30/2023:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility