Inspection Reports for Siebenthal Elder Care Home
7948 Hunts Run Way, Sacramento, CA 95828, CA, 95828
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with several annual and case management visits confirming the facility was clean, in good repair, and compliant with safety regulations. However, some complaint investigations substantiated issues related primarily to medication management, resident rights violations such as unauthorized restraints and coercion, and inadequate supervision, including a $500 civil penalty issued in December 2023 for residents leaving unsupervised. The most recent report from September 30, 2025, was a follow-up visit triggered by a complaint about aggressive handling of residents; it found no new deficiencies but led to staff retraining and a referral for further oversight. Earlier reports showed problems with medication errors, improper restraint use, and staff clearance issues, but corrective actions and training were implemented over time. Several complaint investigations were unsubstantiated, indicating some allegations lacked evidence.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Follow-Up
Census: 6
Capacity: 6
Deficiencies: 0
Sep 30, 2025
Visit Reason
The visit was an unannounced follow-up on an incident that occurred on August 19, 2025, involving residents being handled aggressively during a walk around the facility.
Findings
The facility administrator reported that the involved staff member was on leave pending review, provided a correction plan, and re-trained all staff with violence prevention training. The Licensing Program Analyst referred the facility to the Technical Support Program and scheduled a Non Compliance Conference to ensure compliance with Title 22 regulations.
Complaint Details
The visit was complaint-related, triggered by an email report of residents being handled aggressively. The staff member involved was on leave pending review. The complaint was addressed with corrective actions and training.
Report Facts
Facility staff: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Facility Administrator | Spoke with Licensing Program Analyst regarding the incident and corrective actions |
| Shakaricka Hughes | Licensing Program Analyst | Conducted the unannounced visit and investigation |
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 0
Sep 2, 2025
Visit Reason
A case management visit was conducted regarding an incident that occurred on 2025-08-19 involving aggressive behavior by facility staff toward residents.
Findings
No deficiencies were observed or cited during the case management visit. Corrective actions were implemented including suspension of the involved staff pending investigation outcome.
Report Facts
Facility staff present: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Facility Administrator | Met with Licensing Program Analyst during the visit and involved in incident reporting |
| Shakaricka Hughes | Licensing Program Analyst | Conducted the case management visit |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 2
Jul 29, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff were inappropriately restraining a resident and forcing residents to drink water.
Findings
The investigation substantiated that staff coerced residents to drink a specific amount of water before leaving the table, violating residents' personal rights. Additionally, staff were found to be inappropriately restraining a resident using gait belts to secure them to chairs, which was not supported by physician orders and violated postural support regulations.
Complaint Details
The complaint investigation was substantiated. Allegations included inappropriate physical restraint of a resident and coercion of residents to drink water. The findings confirmed violations of Title 22 regulations related to personal rights and postural supports.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Residents were coerced to drink a specific amount of water, violating Title 22 regulation 87468.2(a)(3) regarding personal rights and freedom from coercion. | Type B |
| Residents were physically restrained or tied using gait belts in a manner not authorized by physician orders, violating Title 22 regulation 87608(a)(5) on postural supports. | Type B |
Report Facts
Census: 6
Capacity: 6
Plan of Correction Due Date: Aug 1, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Administrator | Met during inspection and involved in interviews regarding findings |
| Shakaricka Hughes | Licensing Program Analyst | Conducted the complaint investigation visit |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 0
Jul 25, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to multiple allegations including medication errors, physical abuse, verbal and financial abuse, resident supervision, and personal rights violations at Siebenthal Care Home.
Findings
The investigation found no corroborating evidence to substantiate any of the allegations. Interviews with staff, co-complainants, and review of documentation did not support claims of abuse, neglect, or rights violations. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint included allegations of staff giving residents medication not prescribed resulting in hospitalization, rough handling causing a broken nose, restricting resident contact with family, verbal and financial abuse, leaving residents unsupervised, and forcing residents to eat. The investigation was unannounced and conducted by Licensing Program Analyst Kevin Gould. The allegations were found unsubstantiated due to lack of evidence and corroboration.
Report Facts
Facility capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the complaint investigation and unannounced inspection |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation report |
| Ermelinda Siebenthal | Administrator | Facility administrator involved in investigation discussions |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Jul 17, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted to address allegations received on 2025-05-06 regarding staff not ensuring residents' dietary needs were met, staff speaking inappropriately to residents, staff not accommodating residents' needs, and improper medication administration.
Findings
The investigation found the allegations regarding dietary needs, inappropriate speech, and accommodation of residents' needs to be unsubstantiated due to lack of evidence. However, the allegation of improper medication administration was substantiated, with discrepancies found in medication records and storage for three residents, violating Title 22 regulations.
Complaint Details
The complaint investigation was triggered by allegations received on 2025-05-06 concerning staff not meeting residents' dietary needs, inappropriate communication with residents, failure to accommodate residents' needs, and improper medication administration. The dietary, communication, and accommodation allegations were unsubstantiated. The medication administration allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to maintain accurate records of residents' medication, including missing medication and inconsistencies in medication logs. | Type B |
Report Facts
Census: 6
Total Capacity: 6
Residents with medication discrepancies: 3
Plan of Correction Due Date: Jul 24, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shakaricka Hughes | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lita Siebenthal | Administrator | Facility administrator involved in interviews and exit interview |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 1
Jul 17, 2025
Visit Reason
The visit was an unannounced case management inspection to address and manage deficiencies inside the facility.
Findings
The inspection found expired canned and dry goods in the facility's 7-day non-perishable food supply, which poses an immediate health and safety risk to residents. The administrator agreed to dispose of the expired food by the end of the inspection day.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not ensure that 7-day perishables dry and canned goods were of good quality; expired canned and dry goods were observed in the kitchen cabinet. | Type B |
Report Facts
Capacity: 6
Census: 6
Plan of Correction Due Date: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lita Siebenthal | Administrator | Met with Licensing Program Analyst during inspection and acknowledged deficiency |
| Shakaricka Hughes | Licensing Program Analyst | Conducted the inspection and documented findings |
Inspection Report
Complaint Investigation
Capacity: 6
Deficiencies: 0
Apr 24, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to allegations of neglect and lack of supervision, including unexplained injuries to a resident and retention of a resident with a higher level of care need.
Findings
The investigation found the allegations unsubstantiated after interviews with staff, home health providers, and review of medical and facility records. The bruising on the resident was consistent with reported falls and medication effects, and there was no indication the resident required a higher level of care. No deficiencies were cited.
Complaint Details
The complaint was unsubstantiated based on the investigation. The department was unable to corroborate the allegations of neglect/lack of supervision. The resident's authorized representative and staff interviews did not produce additional concerns. The complaint can be amended if new information arises.
Report Facts
Facility capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Ermelinda Siebenthal | Administrator | Facility licensee and met with during investigation |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 4
Capacity: 6
Deficiencies: 0
Jan 17, 2025
Visit Reason
The inspection was conducted as a required 1 year annual inspection of Siebenthal Care Home to evaluate compliance with health and safety regulations.
Findings
The facility was found to be clean, odor-free, and in good repair with all required safety equipment and furnishings in place. No deficiencies were cited during the inspection.
Report Facts
Water temperature: 111
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Administrator | Met with Licensing Program Analyst during inspection and conducted facility tour |
| Kevin Gould | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 1
Jan 17, 2025
Visit Reason
The inspection was a case management visit conducted to address the reporting of incidents to the department, specifically to obtain additional medical records and incident reports for a former resident.
Findings
The inspection found that an incident report dated 9/26/2024 regarding a fall and injury of a former resident was not submitted to the department within the required timeframe as mandated by California Code of Regulations, Title 22, posing a potential health, safety, or personal rights risk to residents.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit a written incident report dated 9/26/24 regarding a fall and injury of a former resident to the licensing agency within the required timeframe. | Type B |
Report Facts
Capacity: 6
Census: 4
Plan of Correction Due Date: Jan 31, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the case management inspection and cited the deficiency |
| Ermelinda Siebenthal | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Plan of Correction
Census: 5
Capacity: 6
Deficiencies: 0
Dec 11, 2024
Visit Reason
An unannounced Plan of Correction (POC) inspection was conducted to ensure previously cited deficiencies have been corrected at Siebenthal Care Home.
Findings
The Licensing Program Analyst observed staff present and in the process of completing medication training. Documentation of scheduled training with a registered nurse was provided, and medication administration records are being submitted weekly to ensure completeness until February 10, 2025.
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the unannounced POC inspection |
| Ermelinda Siebenthal | Administrator | Licensee met with LPA and provided documentation |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Dec 11, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to allegations received on 07/19/2024 regarding staff behavior including yelling, threatening, hitting residents, and tying doors closed to prevent residents from leaving bedrooms.
Findings
The investigation found no evidence to substantiate the allegations. Interviews with staff, residents, and authorized representatives denied the claims, and no physical evidence was observed. No deficiencies were cited under California Code of Regulations, TITLE 22.
Complaint Details
The complaint allegations included staff yelling at residents, threatening residents, hitting a resident, and tying doors closed to prevent residents from leaving bedrooms. The investigation was unsubstantiated based on interviews and observations.
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Ermelinda Siebenthal | Administrator | Facility administrator met with Licensing Program Analyst during investigation |
| Czarrina A Camilon-Lee | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 5
Dec 5, 2024
Visit Reason
An unannounced complaint investigation was conducted following allegations of medication mishandling, inappropriate medication administration, and neglect/lack of supervision at Siebenthal Care Home.
Findings
The investigation substantiated the allegations, finding staff signed off medications before administration, over-medication of a resident, improper medication storage, and lack of overnight awake supervision for residents with dementia.
Complaint Details
The complaint investigation was substantiated based on evidence including medication administration records, staff statements, and observations of medication storage and staff scheduling. The allegations involved medication mishandling and neglect/lack of supervision.
Severity Breakdown
Type A: 4
Type B: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Medication administration records documented medications not yet given to residents, posing immediate health and safety risks. | Type A |
| Insulin medication was not refrigerated as directed prior to first use, posing immediate health and safety risks. | Type A |
| Medications were transferred between containers, which is prohibited and poses health and safety risks. | Type A |
| Medication ordered every other day was documented as administered daily, causing over-medication. | Type A |
| Facility failed to provide awake overnight staff for residents with dementia as required, posing potential health and safety risks. | Type B |
Report Facts
Facility capacity: 6
Resident census: 5
Staff scheduled hours: 122
Plan of Correction due date: Dec 6, 2024
Plan of Correction due date: Dec 13, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Ermelinda Siebenthal | Licensee/Administrator | Facility representative involved in investigation and discussions |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw licensing program and signed report |
Inspection Report
Plan of Correction
Census: 5
Capacity: 6
Deficiencies: 1
Oct 30, 2024
Visit Reason
An unannounced plan of correction (POC) inspection was conducted to ensure previously cited deficiencies have been corrected.
Findings
The facility staff is in the process of obtaining criminal records clearances and health screening/TB tests, with scheduled appointments observed. However, written plans of correction for health screening and criminal record clearances were not received, and an immediate civil penalty was issued for failure to correct the plan of correction.
Deficiencies (1)
| Description |
|---|
| Failure to submit written plans of correction for health screening and criminal record clearances |
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Gould | Licensing Program Analyst | Conducted the inspection and noted findings |
| Holly Williams | Licensing Program Analyst | Conducted the inspection |
| Emerlinda Siebenthal | Administrator | Met with LPAs during inspection |
Inspection Report
Census: 5
Capacity: 6
Deficiencies: 4
Oct 23, 2024
Visit Reason
An unannounced case management inspection was conducted to address deficiencies observed regarding facility staff and resident records maintained by the facility.
Findings
The inspection found multiple deficiencies including lack of a certified administrator, missing or incomplete staff and resident records, staff without current health screenings or criminal record clearances, and residents without current medical assessments for dementia. An immediate civil penalty was issued due to a staff member working without a criminal record clearance.
Severity Breakdown
Type A: 3
Type B: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Criminal Record Clearance not obtained for staff member S6 working since April 2024, posing immediate health, safety, or personal rights risk to residents. | Type A |
| No current certified administrator; expired certificates not renewed, posing immediate health, safety, or personal rights risk to residents. | Type A |
| Personnel Requirements - Staff including licensee and administrator lack current health screening including chest x-ray or intradermal test within required timeframe. | Type A |
| Care of Persons with Dementia - Two of five residents did not have an annual medical assessment and updated needs and services plan as required. | Type B |
Report Facts
Capacity: 6
Census: 5
Deficiency count: 4
Plan of Correction Due Dates: Oct 24, 2024
Plan of Correction Due Dates: Oct 25, 2024
Plan of Correction Due Date: Nov 8, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emerlinda Siebenthal | Licensee / Administrator | Licensee discussed observations with Licensing Program Analyst; noted for administrator certification status |
| Kevin Gould | Licensing Program Analyst | Conducted the inspection and authored the report |
| Czarrina A Camilon-Lee | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Jun 18, 2024
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2024-04-18 alleging staff abuse, withholding food, restricting personal cell phone use, and failure to assist with medical appointments.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with six residents and record reviews indicated no verbal or physical abuse, food withholding, or denial of cell phone use, and confirmed staff assistance with medical appointments.
Complaint Details
The complaint was unsubstantiated based on interviews and record reviews. Four residents denied any abuse, and one resident confirmed having a personal cell phone and staff assistance with medical appointments. Two residents could not corroborate due to dementia.
Report Facts
Residents interviewed: 6
Facility capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tung Truong | Licensing Program Analyst | Conducted the complaint investigation |
| Ermerlinda Siebenthal | Administrator | Facility administrator met during the investigation |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Feb 3, 2024
Visit Reason
An unannounced Required 1 year Annual Inspection Visit was conducted to evaluate the facility's compliance with health and safety regulations.
Findings
The facility was found to be clean, odor-free, and in good repair with all required furniture and safety equipment in place. No deficiencies were cited during the inspection.
Report Facts
Water temperature: 113.8
Fire extinguisher inspection date: Jan 16, 2024
Fire drill date: Dec 12, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ruth Wallace | Licensing Program Analyst | Conducted the inspection and met with the administrator |
| Ermelinda Siebenthal | Administrator | Facility administrator met during inspection |
| Stephen Richardson | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Dec 12, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff did not provide adequate supervision to the residents.
Findings
The investigation found that on 12/8/2023, two residents (R1 and R2) left the facility unsupervised through a side gate, contrary to their Physician’s Report which prohibited unsupervised leaving due to dementia. The residents were found without visible injuries and returned to the facility. The lack of supervision was substantiated as a violation.
Complaint Details
The complaint was substantiated based on evidence that residents R1 and R2 left the facility unsupervised on 12/8/2023, violating care requirements. Immediate civil penalties of $500 were assessed for health and safety violations.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate supervision resulting in residents leaving the facility unsupervised, violating HSC 1569.312(d) which requires awareness of the resident's general whereabouts. | Type A |
Report Facts
Civil penalty amount: 500
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tung Truong | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Czarrina A Camilon-Lee | Licensing Program Manager | Oversaw the complaint investigation and signed the report. |
| Ermelinda Siebenthal | Administrator | Facility administrator who was interviewed during the investigation. |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 1
Jul 27, 2023
Visit Reason
The visit was an unannounced case management visit to follow up on a 30-day eviction notice.
Findings
The facility was found not in compliance with Title 22 regulations due to staff fingerprint clearance and association issues. Specifically, 1 out of 4 staff was not fingerprint cleared prior to working, and 2 out of 4 staff were not associated with the facility before working, posing immediate health and safety risks.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 1 out of 4 facility staff located on the premises during the time of visit was not fingerprint cleared prior to working at the facility. Additionally, 2 out of 4 facility staff were not associated with the facility prior to working, posing an immediate health, safety, or personal rights risk to persons in care. | Type A |
Report Facts
Facility census: 4
Facility capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Administrator | Administrator met during the visit and was advised about staff fingerprint clearance issues |
| Pang Lee | Licensing Program Analyst | Conducted the case management visit and authored the report |
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 2
Mar 8, 2023
Visit Reason
The visit was an unannounced case management visit conducted in response to learned deficiencies from a prior complaint investigation regarding improper eviction and failure to implement Title 22 eviction regulations.
Findings
The facility was found to have improperly evicted a resident without following eviction regulations, denied a prorated refund to the resident's responsible party, confiscated and subsequently lost the resident's cell phone, and planned punitive actions against the resident. These issues posed potential health and safety risks and resulted in technical violations.
Complaint Details
The visit was in response to complaint investigation 27-AS-2022122114395, which substantiated that the facility did not implement Title 22 eviction regulations and improperly evicted resident 1 (R1).
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to issue a refund for fees paid in advance after the resident's personal property was removed from the facility within 15 days as required. | Type B |
| Confiscation and loss of resident's cell phone, violating personal rights of residents to keep and use their own personal possessions. | Type B |
Report Facts
Capacity: 6
Census: 6
Plan of Correction Due Date: Mar 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Avelina Martinez | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Czarrina A Camilon-Lee | Licensing Program Manager | Supervisor overseeing the licensing program and deficiencies |
| Emerlinda Siebenthal | Administrator | Facility administrator met during the visit and involved in the findings |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Mar 8, 2023
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint received on 2022-12-21 regarding wrongful eviction and other allegations at Siebenthal Care Home.
Findings
The investigation substantiated the allegation that the facility did not provide a 30-day eviction notice to resident 1, violating eviction procedures. Other allegations related to medical appointments, medication administration, and communication were found unsubstantiated due to lack of evidence.
Complaint Details
The complaint investigation was substantiated for wrongful eviction due to failure to provide a 30-day eviction notice. Other allegations regarding medical appointment attendance, timely medical attention, communication, and medication administration were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide resident or responsible party a 30-day eviction letter and/or notice as required by eviction procedures. | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: Mar 20, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Avelina Martinez | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Ermelinda Siebenthal | Administrator | Facility administrator met during the investigation |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Feb 23, 2023
Visit Reason
An unannounced annual inspection was conducted to ensure compliance with Title 22 regulations, including inspection of the physical plant and facility conditions.
Findings
The facility was found to be sanitary, clean, and in good repair with no deficiencies cited. The administrator holds a current certificate, and the facility has an approved hospice waiver for two residents.
Report Facts
Facility capacity: 6
Census: 6
Water temperature: 105
Facility temperature: 76
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Avelina Martinez | Licensing Program Analyst | Conducted the annual inspection and toured the facility |
| Ermelinda Siebenthal | Administrator | Facility administrator met during inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jan 28, 2022
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements for the facility.
Findings
The facility was found to be clean, odor-free, and in good repair with sufficient furniture, lighting, and food supplies. Fire safety equipment and medication storage were compliant. No deficiencies were found during the visit.
Report Facts
Hot water temperature: 115.2
Thermostat temperature: 75
Fire extinguisher last serviced: Mar 10, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Administrator | Met with Licensing Program Analyst during inspection; holds certificate #0001130740 |
| Anthony Tuck | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Czarrina A Camilon-Lee | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jun 22, 2021
Visit Reason
An unannounced annual/random inspection was conducted to evaluate compliance with regulations and licensing requirements for the facility.
Findings
The facility was found to be clean, odor-free, and in good repair with sufficient furniture, lighting, and food supplies. Fire safety equipment and medication storage were compliant. No deficiencies were found during the visit.
Report Facts
Hot water temperature: 120
Fire extinguisher last serviced: Mar 8, 2021
Thermostat temperature: 78
Certificate expiration date: Jun 12, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ermelinda Siebenthal | Administrator | Met with Licensing Program Analyst during inspection and named in report |
| Anthony Tuck | Licensing Program Analyst | Conducted the inspection and authored the report |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 2
Nov 5, 2020
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that facility staff were not meeting the resident's diapering needs and were using restraints on a resident.
Findings
The investigation substantiated that the administrator failed to ensure the resident was checked throughout the night for incontinence care, resulting in the resident being found soaked each morning. Additionally, the administrator used a postural support strap without prior physician approval, which was later obtained after the complaint was filed.
Complaint Details
The complaint investigation was substantiated. Allegations included failure to meet the resident's diapering needs and unauthorized use of restraints. The administrator admitted to placing a diaper and pull-up on the resident and failed to obtain prior physician approval for a postural support strap. Evidence included photographs, interviews, and documentation.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| The administrator failed to obtain a written order from a physician for use of a postural support strap prior to use with the resident. | Type A |
| The administrator failed to ensure that the resident was checked for incontinence care throughout the night and kept clean and dry. | Type B |
Report Facts
Capacity: 6
Census: 5
Plan of Correction Due Date: Sep 18, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anthony Tuck | Licensing Evaluator | Conducted the complaint investigation and authored the report |
| Ermelinda Siebenthal | Administrator | Facility administrator interviewed and named in findings |
| Stephenie Doub | Supervisor | Supervisor overseeing the licensing evaluation |
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