Oak Tree Ranch

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with staff Krystal Boyles-Ambrecht. There are residents with a diagnosis of dementia. Required postings were observed. Annual fees are current. LPA/staff initiated a tour of the facility and observed the following: Facility was a comfortable temperature and passageways were free from obstructions, but it was observed by staff/LPA a sink leaning against the wall located on the deck outside in the front area of the facility along with some sheet rock pieces that needed to be removed (technical violation issued). Facility has a pool that is surrounded by a locked gate to ensure resident safety. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Water temperature in resident's bathrooms measured at 114.4 and 114. 8 degrees F in bathrooms, which are within the range allowed by regulation. LPA/staff observed non-skid mat in residents' bathrooms were missing a technical violation issued, because LPA will address this deficiency in the complaint #21-AS-20260812154102. Toxins were inspected and are stored in the locked laundry room. At least two days of perishable and one week of nonperishable food was available. Fire extinguishers were last inspected May, 2026. Smoke alarms throughout the facility and carbon monoxide detector were tested and operational. Last disaster drill conducted on 1/23/2026 which is not within the last quarter (technical violation issued). Continue on LIC809C... Continued from LIC809... LPA initiated file review at 9:30 am. Three staff and five resident files were reviewed. All staff first aid/CPR certificates are current and completed additional required 20 training hours. All residents have care plans updated and all medical assessments were current. During file review, LPA noticed that resident (R1) has a diagnosis of diabetes type 2, which it is been treated with insulin. According to staff, R1 has a glucose monitor attached to their body to monitor their glucose levels, but the facility staff prepares the injections for R1 to administer the injections themselves. However, R1's physician report revealed that R1 is not able to administer own injections. LPA had a conversation with staff indicating that the facility does not have a skilled professional to assist R1 with glucose injections. R1's care plan indicates the need of assistance with medications including insulin administration. Administrator agrees to contact R1's physician to obtain an updated physician report/letter indicating that R1 is able to administer injections by themselves with assistance from staff to prepare medication or they agree to hire a skilled professional. Administrator Certificate for Pamela Johnson 7005563740 expires on 7/27/28. Medication and medication records were reviewed. Administrator will submit updates for the following documents by 8/25/26: LIC500- Personnel Report, LIC308- Designation of Administrative Responsibility and copy of Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 18, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with staff Krystal Boyles-Ambrecht. There are residents with a diagnosis of dementia and residents receiving hospice services. Required postings were observed. LPA/staff initiated a tour of the facility at approximately 9:00 am and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Facility has a pool that is surrounded by a locked gate to ensure resident safety. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Water temperature in resident's bathrooms measured at 116.8, 114. 8 and 112.1 degrees F in bathrooms used by residents in care, which are within the range allowed by regulation. LPA/staff observed toilet handle was loose and staff fixed it immediately (technical violation issued). Toxins were inspected and are stored in the locked laundry room. At least two days of perishable and one week of nonperishable food was available. Fire extinguishers were last inspected May, 2025. Smoke alarms throughout the facility and carbon monoxide detector were tested and operational. Last disaster drill conducted on 7/24/2025. At approximate 9:15 am during tour of the facility LPA/staff discovered a monitor outside of bedroom# 3. Additionally, LPA reviewed the facility house agreement and there is no information regarding the use of a monitor. Per staff, resident's responsible party brought the device because they used to monitor resident when they were at their home. Staff removed and discarded the monitor immediately. Continue on LIC809C... Continued from LIC809... LPA initiated file review at 9:30 am. Two staff and four resident files were reviewed. Staff First Aid/CPR Certificates are current, but one out of two staff (S2) needs to complete additional required 20 training hours. Three out of four residents (R1, R2 & R3) care plans needs to be updated. All medical assessments were current. Administrator Certificate for Pamela Johnson 7005563740 expires on 7/27/26. Annual fees are current. At approximately 10:30am a spot check of medication conducted by LPA and medication records revealed that centrally stored medication log has not been maintained by the facility for all residents' (R1, R2, R3 & R4) medications. Also, LPA learned that resident's (R1) prescribed medication: Aspirin 81mg expired 1/2024; Resident's (R2) prescribed medication: Voltaren cream expired 3/28/2025; Resident's (R3) prescribed medication: calcium/D3 600mg expired on 11/2024, joint free glucosamine dietary supplement expired on 3/28/25 and Tylenol 500mg expired on 1/2024. According to staff, the facility started the transition to a computerized system to keep track of medication records to be automatically updated for them, but the program was not working properly, so they went back to use paper documentation for centrally stored medication logs, but they forgot to enter the medication back into the log for these medications. During the visit, staff have entered the medication information into the log. Medications are kept in a locked cabinet in the kitchen. The facility submitted updates for the following documents: LIC500- Personnel Report, LIC308- Designation of Administrative Responsibility and Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff and a copy of this report was printed for the facility.the state’s words, verbatim · CDSS document, Jul 25, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with staff Krystal Boyles-Ambrecht. The annual fees are current. There are residents with a diagnosis of dementia and no residents receiving hospice services. Required postings were observed. LPA/staff initiated a tour of the facility at approximately 11:30 am and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Facility has a pool that is surrounded by a locked gate to ensure resident safety. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Water temperature in resident's bathrooms measured at 101.3, 103.1 and 101.8 degrees F in bathrooms used by residents in care, which are not within the range allowed by regulation. Toxins were inspected and are stored in the locked laundry room. At least two days of perishable and one week of nonperishable food was available. Fire extinguishers were last inspected May, 2024. Smoke alarms throughout the facility and carbon monoxide detector were tested and operational. Auditory alarms are operational. Last disaster drill conducted on 5/16/2024. Medications in a locked cabinet in the kitchen. At approximate 11:45 am LPA/staff observed that toilet located in bathroom #2 was not properly flushing. Also, upon entering to bathroom #3 located in the hallway, LPA/staff smelled a strong odor and it was apparently due to bathroom does not have adequate ventilation. Continue on LIC809C... Continued from LIC809... LPA initiated file review at 12:00pm. Two staff and six resident files were reviewed. Staff First Aid/CPR Certificates are current and additional training hours are complete. One out of six resident's medical assessment needs to be current, care plans for all residents were updated. Administrator Certificate for Pamela Johnson 7005563740 is showing as pending in the Department's list of renewal of administrator's certificate. Medication and medication records were reviewed. Administrator submitted updates for the following documents: LIC500- Personnel Report, LIC308- Designation of Administrative Responsibility and Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff and a copy of this report was printed for the facility.the state’s words, verbatim · CDSS document, Aug 27, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management - Incident visit, and met with Claudia Patricia Magana (Staff). Administrator, Pamela Johnson was not able to come, but was available by phone and gave authorization to staff to sign the report. The purpose of this Case Management Visit is to follow up on another agency report submitted to Community Care Licensing (CCL) on 4/3/24. Based on police records #SD240880063 obtained by LPA, on 3/28/24 at approximate 1:01pm, resident (R1) walked out the facility and was being aggressive to staff (S1) walking down the street and S1 was with R1 at all times. During today's visit, LPA reviewed R1's care plan and physician report dated 3/9/24 who has a diagnosis of dementia. R1's care plan indicates that R1 needs general supervision due to confusion and wandering. Based on interviews with staff (S1), it was confirmed that they were following R1 at all times to ensure their safety while they were wandering away of the facility. Per Administrator, they were in the facility and attempted to re-direct R1, but R1 wanted to keep walking away from the facility, so they had S1 following them around. However, the facility did not notify CCL regarding the incident. LPA had a discussion with Administrator clarifying when an incident report needs to be submitted to CCL. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff and a copy of this report was printed for the facility.the state’s words, verbatim · CDSS document, Apr 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 19, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Dpt may require…(1) A written report shall be submitted to the licensing agency & person responsible for the resident within 7 days of the occurrence of any of the events…(D) Any incident which threatens the welfare, safety or health of any resident...unexplained absence of any resident. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted with Administrator confirmed that they did not ensure that CCL was notified of incident involving R1 after AWOL, which poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2024

Plan of correction: Administrator to ensure all incidents that threaten the safety of residents are reported to CCL per regulation. Administrator to review regulation, conduct training for all staff on reporting requirements. Signed statement that the regulation was reviewed & sign in sheet for all staff trained to be submitted by POC due date.

Allegation investigated: -Staff do not maintain facility sanitary. -Staff do not maintain facility in good repair.

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 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.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 21-AS-20240124112117