Facility Evaluation Report

LPA Hiratsuka conducted this unannounced annual visit. Administrator Lopez arrived during visit. Two caregivers were on duty when LPA arrived.

Licensee increased capacity this year to five residents. This facility has a fire clearance for four 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 a resident room with 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 the end of the month

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility