Siebenthal Care Home

Limit operations to licensed capacity

Based on facility observation the licensee did not comply with the section cited above which poses an immediate health and safety risk to persons in care. During an annual inspection, the Licensee informed the LPA that the facility has admitted an additional resident (R3). The licensee stated that another resident is currently occupying the bedroom previously assigned to resident (R2). The licensee reported that R2 is not currently residing at the facility and is staying at a seperate property owned by the licensee that is not licensed by the Dept. The licensee further stated that R2 returns to the facility during the daytime hours. At the time of the inspection the facility reported a census of seven (7) residents.

Record dose details and resident medication response

Based on facility observation the licensee did not comply with the section cited above in 1 out of 1 count which poses an immediate health risk to residents in care. During review of Medications records for residents, it was observed that resident (R1) Medication Administration Record (MAR) was not signed for one (1) medication for 9 days for the month of March 2026.

Prohibit tying or restricting resident hands or feet

87608 Postural Supports.(a)Based on the individual's preadmission appraisal..(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement was not met as evidenced by: Licensee did not ensure that residents in care were assisted in a manner that upholds their personal rights, including freedom from being physically restrained or tied.

87468.2 Additional Personal Rights for all Residents in Privately operated Facilities.(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights.(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, as citizens and as residents of the facility. Residents shall be free from interference, coercion...This requirement was not met as evidenced by: Licensee did not ensure that residents in care were protected from coercion being required to drink a specific amount of water.

Food quality controls and rejected damaged goods

87555 General Food Service Requirements. (b) The following food service requirements shall apply. (8) All food shall be of good quality. Commercial foods shall be approved by appropriate... Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by: Licensee did not ensure that 7-day perishables dry and canned goods were of good quality. LPA Hughes observed canned and dry goods in the kitchen cabinet expired. Administrator agreed that expired canned goods and dry foods should be disposed of immediately.

Maintain records of centrally stored medication dosages

Incidental Medical and Dental Care 87465. (a) A plan for incidental medical and dental care shall be developed by each facility.(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained..This requirement was not met as evidenced by: Licensee did not ensure that a accurate record of resident's medication were accurately maintained in the facility. R1,R2,R3 medication logs were not accurately recorded, CSMDR record was missing from R2 resident medication log, including inconsistencies in the start date and amount of medication on hand.

written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case... Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement was not met as evidenced by and incident report obtained from the facility dated 9/26/24 was never submitted to the department as confirmed by facility staff which poses a potential health, safety or personal rights risk to residents in care.

Incidental Medical and Dental Care: The preservation of medicines requires refrigeration, if the resident has no private refrigerator. This requirement was not met as evidenced by LPA observations of insulin medication not stored in a refrigerator prior to first use as directed on the prescription directions which poses an immediate health safety and personal rights risk to residents in care.

In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. This requirement was not met as evidenced by LPA observations of staff schedule and statements obtained form the licensee that there are times where there is not an awake staff member on duty which poses a potential health, safety and personal rights risk to residents in care.

Arrange appropriate medical and dental care

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by LPA reviewed of three resident medication administration records which documented medications that had not yet been given to the residents which poses an immediate health, safety and personal rights risk to residents in care.

Give PRN medication by physician order

Incidental Medical and Dental Care: Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by LPA review of R1's medication administration records which showed documentation of a medication ordered to be given every other day is documented as being administered to R1 daily which poses an immediate health, safety and personal rights risk to residents in care.

Keep prescriptions in original containers

Incidental Medical and Dental Care: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by LPA review of centrally stored medications and statements obtained from staff member that they have transferred medications from one prescription container to another which poses an immediate health, safety and personal rights risk to residents in care.

Care of Persons with Dementia: Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by LPA observations that two of the five resident's in placement did not have an annual 602 and needs and services plan updated annually pre regulations which poses a potential health, safety or personal rights risk to residents in care.

Submit and maintain current mailing address

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met as evidenced by statements from S1 regarding S6's working at the facility since April 2024 without a criminal record clearance which poses an immediate health, safety or personal rights risk to residents in care.

Certified administrator requirements and substitute coverage

Administrator - Qualifications and Duties: All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section... this requirement was not met as evidenced by: LPA observations there is no current certified administrator and the administrators whose certificate expired has yet to submit documents for renewal which poses an immediate health, safety or personal rights risk to residents in care.

Health screening and fitness requirements

Personnel Requirements - General: All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall test, performed bya be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents wich poses an immediate health, safety or personal rights risk to residents incare.

Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services:...(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidence by: Based on interviews and record review, the facility did not comply with section cited above in 1569.312(d). R1 and R2 AWOL'D from facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This poses an immediate health and safety risk to the resident in care.

Obtain California clearance or exemption

87411(g)(2)Personnel Requirements - General(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:(1) (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or Based on observations and record review, the licensee did not ensure 1 out of 4 facility staff located on the premises during the time of visit fingerprint cleared prior to working at the facility. It was also learned that 2 out 4 facilityn staff was also not associated to the facility prior to workinag at this faility, which poses/posed a immediate health, safety or personal rights risk to persons in care.

1569.652(c)A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals....within 15 days after the personal property is removed. This requirement was not met as evidence by: Based on file review and interviews: the Licensee refused to provide a refund to R1 due to his behavior. This posed a potential health and safety risk to R1.

Grounds for eviction listed for residents

87224(a) Eviction Procedures: the licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...This requirement was not met as evidence by: based on file review and interviews, the Licensee did not ensure to provide R1 or their responsible party a 30-day eviction letter and/or notice. This posed a potential health and safety risk to R1.

87468.1(a)(3) Personal Rights of Residents in all Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: or wear their own clothes; to keep and use their own personal possessions...This requirement was not met as evidence by: Based on record review and interviews, the Licensee confiscated R1's cell phone, which the cell phone is now missing This posed a potential health and safety risk to R1