Siskiyou Springs Assisted Living and Memory Care

Type of visit: Required - 1 Year

On September 22 2026 Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Cinde Conley Pacheco (cert #6078463740 exp.08-26-27) and explained the purpose of the visit. Administrator certificate is current. forty-nine (49) residents and nine (9) staff were present in the facility during the inspection. LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to five (5) resident rooms, common areas, three (3) bathrooms, kitchens, memory care, storage areas and yard. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked closet. All bedrooms had required furniture, bedding, lighting and windows with screens. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The areas observed were found to be odor-free, clean and in good repair. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Fire extinguisher last inspected in 2-28-26. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities planned for the clients. All required postings are displayed within the facility. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 05-28-26, the facility will be conducting drills every 3 months. LPA interviewed three residents and two staff. The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, a copy of the report, and appeal rights provided to administrator.the state’s words, verbatim · CDSS document, Sep 22, 2026

Allegation investigated: Staff are not repositioning resident.

On 09-21-26, Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06-02-26. LPA Benson met with Administrator Cinde Pacheco and explained the purpose of the visit. During the interview process, three staff persons and one resident were interviewed. The following documents were received and reviewed: staff list with telephone numbers and work schedule, client roster, client admission agreements, hospice records, medical records, MAR and plan of care. Substantiated Continued on LIC9099C and LIC9099D Substantiated Staff are not repositioning resident. During staff interviews, S1 stated when I am with care staff they are repositioning the residents but can do better at recording it. S1 stated that R1 is not happy with repositioning at times and uncomfortable with pillows for support at times. S2 stated at one point our staff tried to assist the resident to a bedside chair. S2 stated during the transfer R1 lifted their feet requiring staff to hold R1’s body weight making it very difficult for staff. S2 stated R1 was very unstable with their core and not stable enough to sit alone. S2 stated I reposition the resident, S2 stated at the beginning it was difficult to reposition because of R1's bloat and pain. S2 stated R1 was put on lasix and then we were able to move her. S2 stated R1 would panic when put on her side, she thought she might fall out of bed. S2 stated R1 could not stand to transfer, she could not or would not stand anymore. S2 stated It took four of us to get R1 out of bed, so Hospice gave orders to not get her out of bed, it was too dangerous. LPA observed R1 is on Hospice with orders to reposition resident every 2 hours. LPA's record review of resident care log, revealed the majority of the time there is no record of repositioning/transferring of R1. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.the state’s words, verbatim · CDSS document, Sep 21, 2026 · control 59-AS-20260604153534

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(d) · Plan of correction due date: Oct 21, 2026

Hospice Care of Terminally Ill Residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above, the majority of the time there is no record of repositioning/transferring of R1. Which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 21, 2026

Plan of correction: Administrator will have a staff training of hospice care and record keeping. Administrator will have staff notify them when unable to meet the needs of residents in care. Administrator will notify LPA when completed.

Allegation investigated: Facility is not giving resident their pain medications.

On 09-21-26, Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06-02-26. LPA Benson met with Administrator Cinde Pacheco and explained the purpose of the visit. During the interview process, three staff persons and one resident were interviewed. The following documents were received and reviewed: staff list with telephone numbers and work schedule, client roster, client admission agreements, hospice care records, medical records, MAR, cleaning schedule and care plan. Substantiated Continued on LIC9099C and LIC9099D Substantiated Staff is not keeping the resident rooms clean. During staff interviews, S4 stated there have been times the room was in disarray, but not dirty. S3 stated In R1’s previous upstairs room there was a lot of clutter, she didn’t like anyone going through her stuff. S3 stated I moved all of the non-ambulatory people downstairs. S3 stated we moved R1 from upstairs to downstairs and cleaned up her room. S3 stated the family donated a lot of her stuff as her room was cluttered. S3 stated I did see medical wrappers on R1’s floor, I could see that staff had a hard time putting garbage into a garbage can. LPAs’ observations during the visit: the room to be clean, dust free and orderly. LPA observed the garbage container was emptied. Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated. Facility is not giving resident their pain medications. During staff interviews, S3 stated staff should ask R1 every shift what their pain level is. S3 stated other staff are resistant to give morphine or Ativan. S3 stated at one point R1 was very sedated, so staff were informed, don’t give pain medication over the weekend. S4 stated there was a transitional period from the prn to the scheduled every 12 hours. S4 stated protocol is check every two hours, the RA’s report if they see any grimacing or restlessness. S4 stated at this time R1 is taking the long last q 12 hours scheduled at this time. S4 stated R1 has had no pain sense then. S4 stated in the past R1 would say her pain was always 8, even after I gave the pain medication. S4 stated If I ask R1 now what her pain level is, she would say no pain. S4 stated we had a med. tech that was negative about hospice outcomes, scared of controlled medication in a syringe. S4 stated I gave the PRN medication as needed. Record review revealed R1s doctor prescribed pain medication May 21 2026 every hour as needed for pain. Review of the medication administration record, records only one dose given between May 28 and June 3 2026. The resident was not administered their pain medication. During Resident interviews LPA Benson ask R1 is they were in pain, they reported yes, they are always in pain. Resident interviews revealed that the resident was in pain. At this time It was reported the resident is getting consistent pain medication and is no longer in pain. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.the state’s words, verbatim · CDSS document, Sep 21, 2026 · control 59-AS-20260602164239

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 21, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above in the resident was not assisted with medicaion as needed. Which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 21, 2026

Plan of correction: Administrator will have a staff training concerning Hospice PRN medication and the administration. Administrator will notify LPA when complete.

Type of visit: Case Management - Incident

On 09-21-26, Sarah Benson, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint. LPA Benson met with Administrator Cinde Pacheco and explained the purpose of the visit. During the visit LPA Benson and Administrator Cinde Pacheco inspected the memory care unit to insure the health and safety of residents in care. In the memory care unit LPA Benson observed a resident coloring and five residents watching T.V. In the memory care unit LPA Benson observed a bottle of over the counter medication on a table in a resident room. The administrator stated the resident is new and the family will be by later today to pick up medication and other items as they are not allowed in memory care. Family arrived during LPA's visit and LPA was able to verify the resident needs a doctors order for over the counter medication left in residents room. LPA observed the medication was taken to the medication room and was informed the doctor will be contacted for a new prescription. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Continued on LIC809-D An exit interview was conducted, and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 21, 2026

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored: (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: Based on observation and interview, the licensee did not comply with the section cited above as medication was not locked in a safe place not accessible to persons in care. Which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 21, 2026

Plan of correction: Administrator will have a staff medicaion training concerning accessibility of over the counter medication. Administrator will notify LPA when training is completed.

Type of visit: Case Management - Incident

On June 12 2026, Licensing Program Analyst (LPA) Sarah Benson arrived at the facility to open two complaints and conduct an unannounced case management in response to a phone call received from a family member 6-12-26. The family member stated they had called the facility three times and were unable to talk to staff. LPA met with Resident Care Coordinator and explained the purpose of the visit. LPA Benson and Resident Care Coordinator (RCC) inspected the memory care unit. LPA Benson observed residents playing bingo. LPA Benson left resources for facility activities. See attached 812's for interviews. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. An exit interview was conducted, and a copy of the report and appeal rights were provided. LPA Benson and Resident Care Coordinator (RCC) inspected the memory care unit and hospice residents rooms. Upon entering the memory care unit LPA Benson observed an over powering cleaning solution or air freshener smell. LPA Benson observed the laundry room open with a gallon size container of laundry soap left unattended. RCC closed the locked door to laundry room so the laundry soap was locked in storage area with LPA present. LPA observed resident rooms and bath rooms clean with required supplies. See attached 812's. Continued on LIC809Dthe state’s words, verbatim · CDSS document, Jun 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Jun 12, 2026

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.the state’s words, verbatim · CDSS document, Jun 12, 2026

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

Type of visit: Post Licensing

On March 4, 2026 Licensing Program Analyst LPA Sarah Benson arrived at the facility unannounced to complete a post-licensing visit. The facility was initially licensed on 09-30-2025. LPA was greeted by Receptionist Patti Daniels. The facility is licensed for ninety-nine (99) residents and currently has (46) forty-six. The facility has an approved hospice waiver for fifteen (15) and currently has four (4) residents on hospice. LPA completed the Facility Inspection Tool. Areas inspected include but are not limited to resident apartments, common areas, kitchen, outside patio, and medication rooms. The facility is in good condition, clean and nicely furnished. The facility is well furnished with appropriate furniture, dishes, pots and pan, etc. LPA and staff toured two (2) residents apartments in the memory care unit, residents apartments were found to be clean and in good repair, hot water temperature was measured in apartments and was within the required range of 105-120 degrees F. LPA and staff toured two (2) assisted living apartments. Resident apartments were found to be clean and in good repair, hot water temperature was measured in apartments and was within the required range of 105-120 degrees F. Lighting is appropriate throughout the facility. Food supplies were reviewed and appear appropriate to meet the requirement of 2 days perishable and 7 days non-perishable supplies. LPA reviewed staff records and client records. Staff records include fingerprint clearance, physician reports, TB clearance, current First Aid/CPR certification, records of ongoing training. Administrator certificates are current. Resident files include signed admission agreements, updated physician reports, assessments, care plans, signed consents, rights, etc. The following deficiencies are being cited on the attached LIC809-D in accordance with California Code of Regulations, (Title 22). Exit interview completed and a copy with appeal rights was given to the administrator.the state’s words, verbatim · CDSS document, Mar 4, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On 1-2-26 Licensing Program Analyst LPA Sarah Benson arrived at the facility unannounced to conduct a case management visit. LPA Benson met with Administrator Cindy Conley Pacheco and explained the purpose of the visit. The department is following up on an incident report sent by the facility on 12-29-25 stating that a resident, R1 had a un-witnessed fall with a broken hip requiring surgery. The LPA performed interviews and records were reviewed. LPA Benson and Administrator toured the facility together. LPA Benson observed the repair to the dinning room ceiling was completed and the pull cords in memory care are all working. When testing the pull cords it was discovered the pager was not working. The staff used a screw driver to repair the pager during LPA's visit. It was discovered the floors in the residents rooms were not clean. The following deficiencies are being cited on the attached LIC809-D in accordance with California Code of Regulations, (Title 22). Exit interview completed and a copy with appeal rights was given to the administrator. Exit interview conducted and copy of the report left with the administrator.the state’s words, verbatim · CDSS document, Jan 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 2, 2026

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.the state’s words, verbatim · CDSS document, Jan 2, 2026

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.

Type of visit: Prelicensing

09/30/2025 at 11:30 AM Licensing Program Analysts (LPA) Sarah Benson arrived at the facility to conduct the scheduled pre-licensing inspection. LPA met with administrator Cinde Conley Pacheco and explained the purpose of the visit. Comp 3 was presented by LPA’s to licensee during the visit. Comp 3 presentation was completed. The fire marshal has approved the fire safety inspection request. The facility is licensed for 84 non-ambulatory residents and 15 bed ridden residents for a total capacity of 99. The facility has a memory care unit that has seven (7) bedrooms and number (7) bathrooms. The facility also has an assisted living section that has fifty-eight (58) bedrooms and fifty-eight (58) bathrooms. The LPA observed dining area with water damage, dry wall in the ceiling was removed in an area of twenty feet by twenty feet and covered with plastic sheeting taped over opening. LPA observed a seating area with seating for fifty people in the common area. The hot water meets the requirement for licensing within a range of 105 - 120 degrees F. Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave and refrigerator were all present and working. Bedrooms were observed to have furniture as required by Title 22 Regulations. All beds were made up with linens and bedspreads. Each bedroom has ample storage. The facility has a linen closet which contains sheets, pillowcases, towels and face cloths. Bathrooms were observed to be in good repair. The facility has a locked medication cart which is located in the locked medication room. Storage and lighting are adequate in the facility. Cleaning supplies and toxins are locked in janitorial rooms. Knives are locked up in the kitchen. Washers and dryers observed in place and ready for use. The facility has 21 Fire Extinguishers fully charged fire extinguishers which were inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning. There is a locked office space where client and staff files are stored. The yard has a nice, shaded structure with outdoor furniture for residents to use. The applicants will complete the POC for deficiencies and repair the dinning room water damage to complete pre-licensing. When completed the LPA will contact the Central Application Bureau. The following deficiencies are being cited on the attached LIC809-D in accordance with California Code of Regulations, (Title 22). Exit interview completed and a copy with appeal rights given to the administrator.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Case Management - Deficiencies

On 8-13-25 Licensing Program Analyst LPA Sarah Benson arrived unannounced at the facility to deliver complaint findings for previously licensed facility Siskiyou Springs Senior Living Community (475002711. LPA Benson met with Administrator Cindy Pacheco. LPA Benson and the Administrator toured the facility together. See the following complaint findings: SISKIYOU SPRINGS SENIOR LIVING COMMUNITY, 475002711. 59-AS-20250402153648 reported 4-02-25: 2 complaints Unsubstantiated. 59-AS-20250415150958 reported 4-15-25: 1 complaint Substantiated. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed. An exit interview conducted and a copy of the report was left with Administrator.the state’s words, verbatim · CDSS document, Aug 13, 2025

Allegation investigated: Facility pager system is in disrepair.

/29/2025 at 10:00 AM Licensing Program Analysts (LPA) Sarah Benson made an unannounced visit to the facility and met with Administrator Cindy Pacheco. The purpose of this visit was to open a complaint investigation. During today's visit the facility was toured, records were reviewed and interviews were performed. LPA Benson interviewed 3 staff members. LPA requested the following documents during the visit: staff list with telephone numbers and staff schedule, client roster and incident reports. Continued on 9099C and 9099D Substantiated During staff interviews, it was reported that the electricity and call system went out 7-16-25 at 5:30 am. Staff stated, I made sure all of the residents were checked on every hour. The Administrator reported the most critical residents in assisted living had their doors propped open so staff could hear/attend to them. The administrator reported most of the residents had cell phones and were told to call the front desk when needing staff. The administrator stated the staff were required to check in on each resident at least every forty-five minutes. The administrator reported that the call system is set up to forward the calls to the memory care staff when the front desk staff go home. Staff reported the generator was working and the electricity came back on 7-16-25 at about 10:00am but the call system did not. Staff reported the downed call system to the company in charge. Staff reported by 7-18-25 the company said the system files were corrupt and said we had to get a new system. Staff reported on searching for a new system. Staff reported on 7-21-25 the old system began working again. LPA Benson and staff observed the call system in the office area in working order. Staff stated we are trying to verify where the outlets are that are connected to the generator. Staff stated I want to make sure the call system is connected to the generator. LPA Benson went to room 105 with staff to test the call system. Staff pushed the residents call button at 2:29 pm and staff arrived at 2:37 pm. LPA Benson observed the call system as working. During file review it was discovered that the assisted living area has four care staff during the day and two care staff during the night. File review revealed that memory care has two care staff during the day and two care staff during the night. Record review revealed that the facility has two care staff in momory care and 1 care staff in assisted living for the NOC shift. Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 59-AS-20250728170457

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(1)(A)(B)(C) · Plan of correction due date: Aug 29, 2025

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.the state’s words, verbatim · CDSS document, Jul 29, 2025

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.

Type of visit: Case Management - Other

On 5-19-25 Licensing Program Analyst LPA Sarah Benson arrived at the facility unannounced to deliver complaint findings for previously licensed facility (475002711). LPA Benson met with Carey Eppler Office Manager.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Case Management - Other

On 5-20-25 Licensing Program Analyst LPA Sarah Benson arrived at the facility unannounced to amend complaint findings for previously licensed facility (475002711). LPA Benson met with Carey Eppler Office Manager.the state’s words, verbatim · CDSS document, May 20, 2025