496803864-10-9-2024-21-AS-VBEI-DA2RQP-20241014131348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803864
Report Date: 10/09/2024
Date Signed: 10/09/2024 11:52:48 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2024 and conducted by Evaluator Christi Coppo

COMPLAINT CONTROL NUMBER: 21-AS-20240712134502

FACILITY NAME:	SONOMA OAK TREE HOME		FACILITY NUMBER:	496803864
ADMINISTRATOR:	CHRISTINA ROWLANDS		FACILITY TYPE:	740
ADDRESS:	425 ARBOR AVE		TELEPHONE:	(707) 287-6214
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	6	CENSUS: 6	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Caregiver		TIME COMPLETED:	12:07 PM

ALLEGATION(S):

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Staff is smoking in the facility.
Staff ignored a resident in care.
Staff are not adequately caring for the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegations and met with caregiver. Dina Bruk, Administrator was not at the facility but was available by phone. Administrator gave caregiver permission to sign. Administrator present on phone while LPA delivered findings.

Complaint alleges staff is smoking in the facility. Complainant states that staff smokes marijuana in the living room of the facility. Sonoma County Sheriff’s office was dispatched to the facility on 7/12/2024 event #SD241940089 to investigate allegation of smoking marijuana in facility. Sheriff states in SD241940089 that neighbors on both sides of facility smoke marijuana during the evening and sometimes the smell may travel. Sheriff documented in SD241940089 they did not observe smoking or smell smoke of any kind while present in facility.

Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 21-AS-20240712134502

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SONOMA OAK TREE HOME	FACILITY NUMBER: 496803864
	VISIT DATE: 10/09/2024

NARRATIVE

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Continued from 9099...

Sheriff noted in SD241940089 allegation of smoking marijuana in facility unfounded. Facility has five residents. Two [2] out of five [5] residents are verbal, three [3] are non-verbal. During investigation, LPA interviewed verbal residents. Verbal residents stated they have never smelled smoke of any kind present in facility. During investigation, LPA interviewed four [4] out of eight [8] staff. All four staff members stated they have never smelled smoke of any kind in the facility and have never observed other staff smoking in the facility. Two [2] Licensing Program Analysts (LPAs) visited the facility to investigate allegation of smoking in facility. Neither LPA observed smoking in the facility during visit. Neither LPA smelled smoke of any kind present in facility during visit. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Complaint alleges staff ignored a resident in care. Complainant states a resident that recently passed away would be ignored by staff if they needed help. Facility has five [5] residents. Two [2]out of five [5] residents are verbal, three [3]are non-verbal. During investigation, LPA interviewed verbal residents. Verbal residents state they always receive help when they need it. During investigation, witness interviewed stated observing residents being well taken care of and that their family member receives the best of care here. During investigation, LPA reviewed care plan and charting notes of resident. LPA observed resident’s care plan to list description of care needs. LPA observed charting notes to document daily care provided and daily staff observations. During investigation, LPA interviewed staff and asked about the care needs of resident. Staff stated to LPA the same care needs as LPA observed in care plan and as documented in chart notes. During investigation, LPA interviewed two [2] witnesses, both witnesses report observing residents at the facility receiving prompt care when pressing their pendant. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Complaint alleges staff are not adequately caring for the residents. Complainant states resident had a fall that resulted in a wound, but staff did not pay good attention to resident; staff did not make sure the wound was healing. During investigation, LPA reviewed hospital discharge summary after resident fall. Facility stated to LPA they updated resident’s care plan to include wound care now required, due to resident’s fall.

Continued on 9099C(2)...

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20240712134502

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SONOMA OAK TREE HOME	FACILITY NUMBER: 496803864
	VISIT DATE: 10/09/2024

NARRATIVE

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Continued from 9099C...

LPA reviewed resident’s hospital discharge instructions for wound care, no special instructions were observed. LPA observed resident’s updated care plan and chart notes to state that wound dressing was only to be changed by hospice nurse or designated family member. During investigation, LPA interviewed two [2] witnesses. One [1] witness reports that designated family member was to change wound dressing due to family wanting to track progression of wound healing in "real time," not due to any lack of confidence in staff to appropriately change the dressing. Witness reports that wound healed quicker than anticipated and at no time did the wound become infected. During investigation, LPA interviewed four [4] out of eight [8] staff. Four staff members indicated that resident’s wound dressing was only to be changed by hospice nurse or the designated family member. During investigation, Administrator reported to LPA one instance of resident’s wound dressing coming off during the late evening hours. Rather than wait for a hospice nurse to arrive, Administrator promptly addressed meeting the resident’s wound care needs by having staff dress the wound immediately. During investigation, LPA observed resident’s chart notes to document facility’s daily observation of resident’s mood, daily care needs, food intake, bowel movements, wound care, and medication management. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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