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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496800208
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:35:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/24/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240124112117
FACILITY NAME:OAK TREE RANCHFACILITY NUMBER:
496800208
ADMINISTRATOR:JOHNSON, PAMELAFACILITY TYPE:
740
ADDRESS:1482 OLIVET ROADTELEPHONE:
(707) 571-1122
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 3DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Pamela Johnson (Administrator)TIME COMPLETED:
12:49 PM
ALLEGATION(S):
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-Staff do not maintain facility sanitary.
-Staff do not maintain facility in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Administrator Pamela Johnson.

The Department received an allegation of staff did not maintain facility sanitary. Per anonymous reporting party, the toilet in the second bathroom has mold and black water in it. Also, it was alleged that the wood on the deck at the front entrance of the facility is rotten. During the investigation, on 1/26/24 LPA/staff toured, made observations at the facility including all bathrooms used by residents in care. During the tour of the physical plant the bathrooms appeared clean, free of odors and sanitary. Based on LPA’s observations, the wood on the deck located at the front entrance of the facility was in acceptable condition, no rotten issues were observed. LPA conducted interviews with staff and residents on 1/26/2024 who did not express any concerns about the physical plant of the facility.
Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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 2
Control Number 21-AS-20240124112117
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: OAK TREE RANCH
FACILITY NUMBER: 496800208
VISIT DATE: 03/07/2024
NARRATIVE
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Continues from LIC9099...
Based on LPA’s interviews and observations, LPA has determined and confirmed that although the bathrooms were clean and in a sanitary condition on recent LPA inspection conducted on 1/26/2024, LPA is unable to determine if an area of the facility was unclean or unsanitary condition at a prior date. A finding that the complaint allegation occurred of staff did not maintain facility sanitary is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding the allegation, staff do not maintain the facility in good repair. Per anonymous reporting party, the knobs in the shower in the first bathroom are hard to turn, the third bathroom is under construction and doesn't have a toilet in it. Also, it was alleged that a wall in bedroom number five doesn't have electricity, the facility's electricity comes from "an electrical cord that runs through a threshold into the facility”, and they didn't know where the source of the electricity comes from. Based on LPA’s interviews conducted with Administrator, the facility has started the remodeling process about two months ago, they ensured LPA that there is not going to be any structure changes other than upgrading the flooring, toileting, and painting to the bathroom. On 1/26/24, LPA conducted an unannounced visit to the facility, toured the facility inside and outside, LPA/Administrator confirmed that bathroom #3 is under construction, it was locked during visit and there was no toilet in it. However, the facility has accommodated residents to use other available bathrooms as follows: Resident located in bedroom #1 has a bathroom that is working properly inside their bedroom. Resident located in bedroom #2 uses bathroom #2 for showering and toileting. Residents located in bedroom #3 and 6 who were using bathroom #3 that is currently under construction were instructed to use bathroom #2. Bedroom #5 is vacant at the time of visit. Bedroom#6 has a bathroom inside the room that it is working properly. LPA also reached out to Sonoma County Code Enforcement who confirmed that new toilets and floors do not require a permit, unless they are installing new plumbing, electrical lines, or anything structural with the existing walls. Regarding the electricity issue, Administrator LPA that GFI breaker popped up and it was fixed the same day. During LPA’s visit on 1/26/24, all bedroom’s light fixtures, wall outlets have electricity and there were no electrical cords running by a threshold observed in bedrooms. Based on LPA’s interviews and observations, LPA has determined that facility did ensure that building is safe and in good repair for the safety and well-being of residents in care. Therefore, LPA was unable to either prove or disprove the above allegation. A finding that the complaint allegation occurred of staff do not maintain the facility in good repair is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2