347004958-6-18-2024-27-AS-KHOS-D6KNCK-20240625102052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004958
Report Date: 06/18/2024
Date Signed: 06/18/2024 04:11:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/18/2024 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20240418145238

FACILITY NAME:	SIEBENTHAL CARE HOME		FACILITY NUMBER:	347004958
ADMINISTRATOR:	SIEBENTHAL, ERMELINDA		FACILITY TYPE:	740
ADDRESS:	7948 HUNTS RUN WAY		TELEPHONE:	(916) 689-3595
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 6	DATE:	06/18/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Emerlinda Siebenthal		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff physically abused residents.
Staff verbally abused residents.
Staff withheld food from resident.
Staff did not allow resident to have a personal cell phone.
Staff did not assist resident with scheduling requested medical appointments.

INVESTIGATION FINDINGS:

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On 6/18/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to complete and delivery findings for a complaint investigation received on 4/18/24. LPA met with Administrator Ermerlinda Siebenthal and explained the purpose of the visit.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is insufficient evidence to substantiate the allegations mentioned above. LPA interviewed six (6) residents. Two residents were unable to corroborate due to their diagnosis of dementia. 4 out of 6 residents stated that they were unaware of any verbal or physical abused from staff. Residents reported that they have access to food and telephone. One resident reported that they have a personal cell phone. Residents also corroborated that staff assisted with scheduling medical appointments and provide transportation.

As a result of the investigation, LPA finds the allegations above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of the report was provided to Administrator Ermerlinda Siebenthal.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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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