Routine inspection·March 10, 2026

On 3/10/2026 at 10:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility licensee/administrator Ermelinda Siebenthal. The current census is 7 with 1 facility staff present. This facility is a single story building licensed to serve (6) non-ambulatory residents, however at the time of the visit the facility reported a census of seven (7) residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 111.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety.  The fire extinguisher is located in the entry way and was last serviced on 01/06/2026. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 74 degrees Fahrenheit. LPA observed toxins located in the kitchen cabinet and laundry storage cabinet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 7 residents medications and the medication administration record (MAR) was not complete for one (1) resident. LPA observed the medication administration record for resident (R1) for one (1) medication incomplete for 9 days for the month of March 2026. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 7 out of 7 resident files and they were complete. LPA reviewed 5 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 03/12/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is not in compliance with Title 22 Regulations, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Ermelinda and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.