075601431-3-29-2024-15-AS-KHOS-D45R8E-20240408124745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 03/29/2024
Date Signed: 03/29/2024 05:50:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/27/2024 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240327083732

FACILITY NAME:	WALNUT CREEK WILLOWS		FACILITY NUMBER:	075601431
ADMINISTRATOR:	GOCO, MARISOL		FACILITY TYPE:	740
ADDRESS:	2015 MT. DIABLO BLVD.		TELEPHONE:	(925) 256-8708
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	72	CENSUS: 44	DATE:	03/29/2024
		UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	Reza Madlangbayan, Administrative Assistant		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1. Facility staff serve a poor quality of food

INVESTIGATION FINDINGS:

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On 03/29/2024, at 1:14PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct initial 10-day complaint visit for the above allegations. LPA met with Reza Madlangbayan and explained the reason for the visit. Licensee/Administrator, Elizabeth "Beth" Cortes, was phoned. Beth arrived shortly after but left at 1:56PM.

The following documents were obtained:
1. Copy of menu for March 25-31, 2024

LIC9099-C Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240327083732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: WALNUT CREEK WILLOWS	FACILITY NUMBER: 075601431
	VISIT DATE: 03/29/2024

NARRATIVE

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LIC9099-C Continued...

Allegation: Facility staff serve a poor quality of food
Unsubstantiated

On 03/29/2024 LPA interviewed S1 which stated that there's food deliveries two times a week. S1 stated that the cooks in the kitchen do cook the meals per the menu from scratch. S1 stated that during the resident's admission they will ask on food preference. S1 stated that the facility gets fresh fruits delivered during the week. S1 stated that she is aware that some of the residents have complained about the food for dinner. S1 stated that the Administrator is trying to hiring new cooks.

LPA interviewed R1 who stated that the food is not good. R1 stated that the presentation of the food isn't appealing. LPA interviewed R2 who stated that the food quality could be "upgraded". R2 stated that the food was bland and doesn't think that the cooks are following the scheduled menus

LPA observed fresh fruits in the kitchen pantry: bananas, oranges, cantaloupes, watermelons and strawberries and grapes located in the refrigerator. LPA observed the cooks in the kitchen were prepping and cooking chicken jambalaya which was scheduled on the menu for dinner.

Therefore, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited. Exit Interview conducted and a copy of this report provided to facility supervisor.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

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