SISKIYOU SPRINGS ASSISTED LIVING AND MEMORY CARE

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. Based on observation, the licensee did not comply with the section cited above. The laundry room door was left open with cleaning solutions unattended, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The RCC closed the locked door during LPA visit. The administrator will have a staff training concerning keeping cleaning solutions locked.

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87613(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in one out of two persons did not have training recorded in staff file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2026 Plan of Correction The administrator will have staff complete required training before staring work. The administrator will send a copy to LPA of training when complete. The administrator will place a copy in staff file when complete.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in the facility had no record of quartly drill, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/06/2026 Plan of Correction The facility will plan and perform a quartley drill. The Administrator will send a copy of quartley drill to LPA when complete.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:The floors in the residents rooms had large dust bunnies, dust, hair balls, paper scraps and food under the beds and around the baseboards. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will assign house keeping to clean the memory care area. Admistrator will notify LPA when the memory care is clean. A staff member weekly will be resonsible to verify the cleaning check list is completed.

Deadline recorded: Feb 2, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in thriteen (13) medications were found in a residents room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2025 Plan of Correction Training the staff of medication regulations. Conversation with family of medication regulations. Administrator will notify LPA when complete.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview the licensee did not comply with the section cited above in memory care two resident rooms had no call system cords, two cords were too shrort for use. The dinning room has a twenty by twenty foot hole in the celing with a plastic covering which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/30/2025 Plan of Correction Maintaince will repair the hole in celing. Maintance will replace the pull cords for the call system in memory care and order more pagers. Staff will keep pagers on hand, not in the drawer with working batteries. Administrator will complete pager training. Administrator will notify LPA when complete.

Official classification

Type B

Official code

87303(i)(1)(A)(B)(C)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. This requirement is not met as evidenced by: The facility had no signal system in working order from 7-16-25 until 7-21-25. . This poses an immediate Health and Safety risk to residents in care.

Official plan of correction

The administrator will create a policy for staff to follow when the call system is not working. The administrator will send a copy of the new policy to LPA.

Deadline recorded: Aug 29, 2025. A deadline is not proof that correction was completed.