Senior Care Records.

Facility Evaluation Report

Pelican Hill Care Home, Union City08/29/2024Licence 019200812

Capacity6
Census4
Date signed08/29/2024 04:14:26 PM
The inspector’s account

On this day at around 10:05 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection and met with staff Eufrocina Hernandez. LPA explained to Hernandez the purpose of the visit. Administrator Thera Albers and co Administrator Michael Lim arrived at the facility at a later time. The facility is a Level 4C home vendorized by the Regional Center of the East Bay (RCEB).

One client and two staff were observed upon LPA arrival. Client was observed doing online zoom classes.

LPA inspected the facility inside and out including but not limited to client bedrooms, bathrooms, kitchen, dining area, backyard and living area. There was sufficient lighting throughout the facility. No bodies of water were observed. Passageways and hallways were observed free of obstruction. There was sufficient supply of perishable and non-perishable foods. Sufficient blankets, sheets, towels, hand towels were observed. Fire extinguisher in the kitchen area was observed to be full and last inspected on 11/1/2023. First aid kit was observed complete and updated. Smoke detectors were tested and observed operational. Last fire and earthquake drills were done on 8/10/2024. At around 10:50 am, LPA reviewed 4 client files and 4 staff files. At 12:23 pm, LPA reviewed P&I money and log with Administrator. The facility has sufficient amount of surety bond to cover cash being handled at one time.

The following deficiencies were observed:

at around 10:10 am, 8 bottles of Robitussin were observed unlocked in the refrigerator

at around 10:13 am, LPA observed hot water measured at 126 degrees Fahrenheit

Deficiencies were cited per Title 22 California Code of Regulations. Please refer to Lic 809D.

Exit interview was conducted and Appeal Rights was provided to Administrator.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction