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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 05:29:54 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
06/18/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240618130238
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:
10:30 AM
MET WITH:Lynette Sandoval, Administrator AssistantTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff do not accord dignity to resident(s) in care.
Staff do not ensure that resident's diapering needs are met while in care.
Staff do not ensure that resident's hygiene needs are met while in care.
INVESTIGATION FINDINGS:
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On 03/13/2025 at 10:30 AM, 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.

During investigation, LPA obtained the following documents: Resident Roster, 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-20240618130238
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 accord dignity to resident(s) in care.
Finding: Substantiated

LPA interviewed W1 that stated lack of respect when requesting the caregiver to change their diaper and that it makes them feel uncomfortable. LPA interviewed R1, R2 and R3 and all stated that they don't feel comfortable with some of the caregivers that don't cover them when showering or getting their diapers changed.

Allegation: Staff do not ensure that resident's diapering needs are met while in care.
Finding: Substantiated

LPA interviewed W1 that stated that they were left in a wet diaper until the next shift started. LPA interviewed R1, R2, R3 that all stated that they have been left in wet diapers. R1, R2 and R3 all stated that during the NOC shift that they have to wait till the next shift starts before getting their diapers changed.

Allegation: Staff do not ensure that resident's hygiene needs are met while in care.
Finding: Substantiated

LPA interviewed W1 that stated that the caregivers do not answer their call buttons and that caregiver comes in the room, turn the light off, goes out and doesn't return back.

LPA interviewed R1, R2, R3 and all stated that they have experienced when they use the call buttons specifically during the NOC shift, it takes approximately 30 mins before a caregiver responds. R3 stated that when the caregiver cleans them they are not completely clean and still have "poop" on them.

LIC9099-C Continued...
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: 4 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
06/18/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240618130238

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: DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lynette Sandoval, Administrative AssistantTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff member yells at resident(s) in care.
INVESTIGATION FINDINGS:
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On 03/13/2025 at 10:30 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrative Assistant, Lynette Sandoval, to deliver the findings of above allegations. LPA explained the purpose of the visit with Administrator.

Allegation: Staff member yells at resident(s) in care.
Finding: Unsubstantiated

LPA interviewed W1 that stated S1 yelled at them citing that it was rush time as an excuse. LPA interviewed R1, R2 and R3 that all stated they haven't heard any of the caregivers yelling at residents.

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: 2 of 5
Control Number 15-AS-20240618130238
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 5)

LPA interviewed S1, S2, S3 and all stated that they have not heard or seen any caregivers yell at any of the residents. The subject staff caregiver no longer works at the facility to interview.

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: 3 of 5
Control Number 15-AS-20240618130238
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
HSC
1569.261(b)
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ยง1569.261 Legislative intent; fundamental rights for residents of residential care facilities (b) In establishing this bill of rights, the Legislature intends that persons residing in residential care facilities for the elderly be treated with dignity, kindness, and respect, and that their civil liberties be fully honored.
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Administrator agreed to read the regulation and self-certify. In addition, will conduct a In-Service training with all staff on all shifts with treating residents with dignity, kindness and respect in communication and giving care.
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Based on interviews the licensee did not comply with the section cited above in by treating residents with dignity, kindness and respect including but not limited to how staff communicates while giving care to residents in care which poses a potential health and safety risk and personal rights to persons in care.
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Submit self-certification and in-service training sign-in sheet and a copy of what was covered during training to CCLD by POC due date.
Type B
04/10/2025
Section Cited
CCR
87468.2(a)(4)
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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 submit a detailed plan on how they will ensure that diaper changes and hygiene care needs are completed with staff during all shifts and submit to CCLD for review by POC due date.
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Based on interviews the licensee did not comply with the section cited above in by responding to call light buttons timely, changing diapers including but not limited to making sure residents' are completely cleaned after soiled diaper changes during NOC shift and between shift changes which poses a potential health, safety risk and personal rights 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: 5 of 5