Sonoma Oak Tree Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Licensee Dina Bruk arrived later. Administrator 6071278740 expires 7/17/2026. Facility currently has six (6) residents in care, two of which are currently on hospice. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. All cleaning products are locked in a closet. Laundry soaps are located in the laundry room and are inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 120.9 degrees F in the kitchen and 119.1 degrees F in room #2, 118.1 degrees F in room #3, and 110.4 in room #6, all except for the kitchen temperature are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Licensee will work to get water in compliance with regulation as 120.9 is slightly outside of the requirement of 105 to 120 degrees F. Fire extinguishers were last inspected 07/23/2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Sprinklers are hardwired and last serviced by a vendor in August of 2025. Continued on 809C... Continued from 809... Facility’s last quarterly disaster drill was conducted on 9/30/25. Facility has a backup generator for use during a power outage. Facility continues to rent separate residence in back of facility property. Residence does not share any walls with the facility. The tenants do not access the facility; however, they do use the stacked washer and dryer in the garage. Residents do not have access to the garage. Garage door from inside facility has locking function such that when it is locked it cannot be opened from either side of the door. LPA and caregiver tested locking function. LPA could not access facility from the garage when door was locked. At approximately 11:30am LPA conducted a review of six (6) staff records. Training videos are dated 2010, 2011, 2012, and 2015 respectively. Per licensee, dementia care training material is newer but LPA did not observe dates of publication. LPA observed some training dates present for staff to be on their scheduled days off. Per licensee, training dates reported on training log were completed by both the staff and by her. LPA discussed with licensee providing updated materials for training, especially for dementia care. LPA discussed with licensee importance of maintaining accuracy of training records. LPA discussed with licensee absence of medication training test required per Health and Safety Code (HSC)1569.69. Facility does not employ a designated Med Tech for each shift, so all caregivers administer medication. LPA discussed with licensee HSC requirement of medication test and that this test is required of all staff administering medication. S1 did not have TB clearance on file (deficiency cited, see 809D). At approximately 1:00pm LPA reviewed six (6) out of six (6) resident files. Files complete. At approximately 2:15pm LPA and conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. LPA and licensee discussed medication management requirements regarding the Centrally Stored Medication Log (CSML) and making sure that everything listed on current physician orders is also listed on the CSML, including PRNs. Current physician orders should be signed. If a medication is on the current physician's orders but not listed on the CSML then a discontinuation order must be maintained in the file. LPA reviewed PRN MAR, PRN MAR in compliance with regulation. Continued on 809C(2)... Continued from 809C... Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. 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 licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 6, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a pre-licensing inspection and was greeted by caregiver. Applicant, Dina Bruk was not available to come to the facility. LIC308 designee will sign report. Administrator certification: Dina Bruk Administrator Certificate 6071278740 expires 7/17/2026. At approximately 9:30am LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. LPA observed, within regulation, emergency supply of non-perishable food. Hall closet containing cleaning supplies was locked. Kitchen drawer with sharp knives inaccessible to residents in care. Facility is a one story residence with six [6] bedrooms, five [5] full bathrooms, kitchen and dining and living room common areas. Shaded outside area available for recreation and visitation. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. Rooms that have exit sliding doors have alarms present and functioning. Fire extinguishers were last inspected 7/29/24. Smoke/Carbon Monoxide detectors located throughout the facility are hardwired and last serviced by Stryker Fire and Security in October of 2024. Facility’s last quarterly disaster drills were conducted 10/03/2024. Facility has a backup generator for use during a power outage. Water temperatures read at: 136.8 degrees F in kitchen, 136.4 degrees F in main bath, 117.5 degrees F in room #6, and 135.8 degrees F in room #4, and 135.9 degrees F. Regulation requires water temperatures to be within 105 & 120 degrees F. LPA advised designee all but the 117.5 reading are outside regulation. Designee will work with applicant turn the water heater down and get the temperature down to within regulation. Continued on 809C... Continued from 809... Separate residence with private tenant located in the back of the facility. Residence does not share any walls with the facility. The tenant does not access the facility; however, they do use the stacked washer and dryer in the garage. Residents do not have access to the garage. The following item needs to be corrected prior to LPA submission of facility's application for approval: water temperature throughout the facility must be within regulation of 105 & 120 degrees F. Applicant to provide photos of temperature readings for the following: kitchen, hall main bath, and rooms #6, #4, and #2 that show water temperature within regulation. Once acceptable photographic proof is received by CCL, LPA will submit facility's application for approval. Comp III reviewed. Exit interview conducted with caregiver and copy of report giventhe state’s words, verbatim · CDSS document, Dec 19, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 Method: Telephone call with CAB COMP II Participants: Dina Bruk, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 15, 2024