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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 04/09/2025
Date Signed: 04/09/2025 06:48:01 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
12/12/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241212150702
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: 49DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lynette Sandoval, Administrative AssistantTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff served poor quality food to residents
Staff was unable to communicate due to language barrier
Staff did not respond to resident's requests for assistance in a timely manner
INVESTIGATION FINDINGS:
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On 04/09/2025 at 3:00 PM, 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.

During investigation, LPA obtained the following documents: Resident Registry, admission's agreement, Appraisal Needs and Services, hospice care plan, Physician's Report and Pre-Placement Appraisal


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

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 8
Control Number 15-AS-20241212150702
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: 04/09/2025
NARRATIVE
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Allegation: Staff served poor quality food to residents
Finding: Substantiated

LPA interviewed W1 that stated the food at the facility is not nutritious. W1 stated that lunch, dinner is cold food.

On 03/13/2025, LPA interviewed R1, R2, R3, R4, R5, R6, R7, R8 and R9. R1-R9 all stated that the food served is ok, sometimes it's cold. R1-R9 stated that they have not seen a menu and that they don't have choices.

LPA observed the meals for lunch/dinner on 03/13/2025 and 04/09/2025. Meals observed was a sandwich on wheat bread, lasagna, mixed veggies with a slice of wheat bread.

Allegation: Staff was unable to communicate due to language barrier
Finding: Substantiated

LPA interviewed W1 that stated one of the caregivers, S2, does not speak English and when R1 needed a bed bath, S1 used his phone to translate through Google.

On 03/13/2025, LPA interviewed S1 that stated S2 does not know English and is currently taking classes to learn English. LPA interviewed R1 that stated it is frustrating sometimes to keep asking or telling a caregiver something with your care need and they don’t understand. R1 stated that it would be good if the caregivers utilized a translator app to communicate.



LIC9099-C Continued...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 15-AS-20241212150702
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: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2025
Section Cited
CCR
87468.2(a)(5)
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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: (5) To be served food of quality and quantity necessary to meet their nutritional needs.

This requirement is not met as evidence by:
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Administrator agreed to have ALL staff cooks to take a food course on food, sanitation and preparation of meals and will submit certificates to CCLD by POC due date.
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Based on observation, licensee did not comply with the section cited above by not serving hot food that should be hot, nutritious and of quality and quantity which poses an health, safety and personal rights risk for persons in care.
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Type B
05/08/2025
Section Cited
CCR
87411(d)(3)
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87411 Personnel Requirements – General

(d) All personnel shall be given on the job training...This training...shall provide knowledge of and skill in the following, as appropriate for the job assigned... (3) Skill and knowledge required...including the ability to communicate with residents.

This requirement is not met as evidence by:
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Administrator agreed to create a plan on how to address this issue with communications with language barriers with staff providing care to residents and submit to CCLD by POC due date.
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Based on interview, the licensee did not comply with the section cited above by ensuring staff has the ability to communicate with residents when providing care which poses an health, safety and personal rights risk for 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: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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
12/12/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241212150702

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:
04/09/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lynette Sandoval, Administrative AssistantTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff did not provide resident’s records to resident’s authorized representative
Staff did not ensure resident's room was cleaned and sanitized
INVESTIGATION FINDINGS:
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On 04/09/2025 at 3:00 PM, 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.

During investigation, LPA obtained the following documents: Resident Registry, admission's agreement, Appraisal Needs and Services, hospice care plan, Physician's Report and Pre-Placement Appraisal


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

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 8
Control Number 15-AS-20241212150702
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: 04/09/2025
NARRATIVE
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LIC9099-C Continued...

Allegation: Staff did not provide resident’s records to resident’s authorized representative
Finding: Unsubstantiated

On 12/16/2024, LPA interviewed witness (W). W1 stated that they requested some information regarding Suncrest Hospice and was denied the file by one of the Med Techs Staff (S). W1 stated that they are the responsible party of resident (R) R1.

On 03/13/2025, LPA interviewed staff (S). S1 stated that W1 asked for the shower schedule which included other resident’s names and that is why S2 denied the file to W1. S1 further stated that W1 always had R1’s hospice file.

On 04/09/2025, LPA interviewed S2 that stated the particular file requested was a file that consisted of other residents' care notes and shower schedules written by caregiver staff. S2 stated that they told R1's authorized rep that they couldn't give them the file because the file had other resident's information which is confidential.

Allegation: Staff did not ensure resident's room was cleaned and sanitized
Finding: Unsubstantiated

LPA interviewed W1 that stated they were told by the hospice aide that the bathroom was filthy and smelled of urine. W1 stated that there are four (4) residents that share bathroom and W1 has observed urine and poop on the floor.



LIC9099-C Continued...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 15-AS-20241212150702
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: 04/09/2025
NARRATIVE
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On 03/13/2025, LPA observed the shared bathroom. The bathroom toilet and floor appeared clean. On 04/09/2025, LPA interviewed R2 that stated housekeeping cleans the shared bath room 2 times a week. LPA interviewed S1 that stated housekeeping cleans the bathroom 4-5 times a week. If there is an accident and housekeeping isn’t available, the caregivers will clean the bathrooms.

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 allegations are UNSUBSTANTIATED.

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

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 15-AS-20241212150702
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: 04/09/2025
NARRATIVE
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LIC9099-C Continued...

Allegation: Staff did not respond to resident's requests for assistance in a timely manner
Finding: Substantiated

On 03/05/2025, LPA 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, LPA 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. A copy of this report and appeal rights provided
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 15-AS-20241212150702
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: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2025
Section Cited
CCR
87468.2(a)(4)
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2
3
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6
7
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 create a chart for each caregiver and their rounds. Rounds will have 2hr checks for incontinence and everything else by signing off. Administrator will submit the chart to CCLD by POC due 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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Repeat Violation Civil Penalty Assessed $250.00
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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: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8