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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 03/13/2025
Date Signed: 03/13/2025 05:32:59 PM

Substantiated


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
03/04/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250304113010
FACILITY NAME:WALNUT CREEK WILLOWSFACILITY NUMBER:
075601431
ADMINISTRATOR:CORTES, ELIZABETHFACILITY TYPE:
740
ADDRESS:2015 MT. DIABLO BLVD.TELEPHONE:
(925) 256-8708
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:72CENSUS: 52DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lynette Sandoval, Administrative AssistantTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not respond timely to the residents alerts
INVESTIGATION FINDINGS:
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On 03/13/2025 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrative Assistant, Lynette Sandoval, to deliver the findings of above allegation. LPA explained the purpose of the visit with Lynette and they called the Administrator/Licensee, Elizabeth Cortes, to inform.

During investigation, LPA obtained the following documents: Resident Roster and Staff Roster.



LIC9099-C Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 5
Control Number 15-AS-20250304113010
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: 03/13/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff do not respond timely to the residents alert.
Finding: Substantiated

On 03/05/2025, LPAs L. Alexander and K. Nguyen interviewed fifteen (15) residents (R). R2, R3, R4, R6, R7, R8, R9, R13, R14 all stated that when they use their call button for assistance with care, it will take from 20 to 30 mins before someone comes to their room to respond. R2, R3, R4, R6, R7, R8, R9, R13, R14 stated that the caregiver comes to the room, turns the light off and then never returns. R7 most of the time it is during the night shift that doesn’t show up to work and weekends. R5 stated that once they had to wait for the following day before someone would come help them. R5, R10, R12 and R15 stated that they have no use for the call button. R5 stated that they heard their neighbor yelling out to the staff for help and said, “I pressed my call button but how come no one here to help me”. R5 further stated that the staff came to their neighbor’s room and just said I will come back but never did.

On 03/05/2025, LPAs tested the call button while waiting for a response in a resident’s room. The time of the test was around 1:00 pm and it took approximately 16mins before a caregiver responded.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250304113010
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2025
Section Cited
CCR
87468.2(a)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Administrator agreed to provide a written plan to address the long response time for call button. Administrator will submit the written plan to CCLD for review by POC date.
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Based on observation, interview and record review, the licensee did not comply with the section cited above by not, including but not limited to, responding to residents' call buttons in a timely manner and addressing the residents' care needs after turing off the call light which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/04/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250304113010

FACILITY NAME:WALNUT CREEK WILLOWSFACILITY NUMBER:
075601431
ADMINISTRATOR:CORTES, ELIZABETHFACILITY TYPE:
740
ADDRESS:2015 MT. DIABLO BLVD.TELEPHONE:
(925) 256-8708
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:72CENSUS: 52DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lynette Sandoval, Administrator AssistantTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff do not meet the residents hygiene needs
Staff do not properly safeguard a resident's personal belonging
INVESTIGATION FINDINGS:
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On 03/13/2025 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrator Assistant, Lynette Sandoval, to deliver the findings of above allegations. LPA explained the purpose of the visit with Administrator Assistant and Lynette phoned Administrator/Licensee, Elizabeth Cortes, to inform.

During investigation, LPA obtained the following documents: Resident Roster and Staff Roster.


LIC9099-C Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250304113010
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: 03/13/2025
NARRATIVE
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LIC9099-C

Allegation: Staff do not meet the residents hygiene needs.
Finding: Unsubstantiated

On 03/13/2025, LPA interviewed witness (W). W1 stated that there were a number of residents at the facility who require and have requested nail care, but are not getting them regularly. W1 stated they are also told they cannot have more than one shower. , the nail care is still not being done regularly, and neither is the showers, due to there not being enough staff to provide the services.

LPA interviewed residents (R). R1, R2, R3, R4 and R5 all stated that they get their showers which is scheduled. R1 stated that they get one (1) shower a week but they don't want more than one and it is there choice. LPA interviewed staff (S). S1 stated that they implemented a nail care schedule and that one of the Med Techs is following up with all the residents that need nail care. LPA reviewed Walnut Creek Willows Wellness Log dated 02/07/2025 that included all residents in both North and South wings with a schedule to have nail care scheduled and completed.

Allegation: Staff do not properly safeguard a resident's personal belonging
Finding: Unsubstantiated

LPA did not receive any details to which resident was missing items delivered on one day and then missing the next day. LPA interviewed S1 about missing delivered items and S1 stated when packages are delivered the facility gives the items to the residents.

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.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5