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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004958
Report Date: 08/28/2020
Date Signed: 08/28/2020 03:01:53 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2020 and conducted by Evaluator Anthony Tuck
COMPLAINT CONTROL NUMBER: 27-AS-20200821162948
FACILITY NAME:SIEBENTHAL CARE HOMEFACILITY NUMBER:
347004958
ADMINISTRATOR:SIEBENTHAL, ERMELINDAFACILITY TYPE:
740
ADDRESS:7948 HUNTS RUN WAYTELEPHONE:
(916) 689-3595
CITY:SACRAMENTOSTATE: ZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
08/28/2020
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ermelinda SiebenthalTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility is not providing resident documents upon request to authorized party
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
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12
13
Licensing Program Analyst (LPA) Anthony Tuck made an initial 10-day complaint investigation tele-visit on 08/28/2020. LPA spoke with Administrator Ermelinda Siebenthal and explained the purpose of the call.

LPA interviewed Responsible Party and Administrator. LPA received copies of emails and text message transcripts. Based upon review of the documentation and interviews. The Responsible party received the requested documentation within the required time allowed from the facility.

This agency has investigated the allegation listed above. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. Exit interview was conducted with Ermelinda Siebenthal. Copy of the report sent to Ermelinda Siebenthal via e-mail with a "read receipt" to verify the LIC 9099 was received. Ermelinda is to print out the report, sign it, and fax a signed copy to LPA at 916-263-4744

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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