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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601431
Report Date: 02/03/2026
Date Signed: 02/03/2026 06:48:20 PM

Document Has Been Signed on 02/03/2026 06:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 WILLOWSFACILITY NUMBER:
075601431
ADMINISTRATOR/
DIRECTOR:		CORTES, ELIZABETHFACILITY TYPE:
740
ADDRESS:2015 MT. DIABLO BLVD.TELEPHONE:
(925) 256-8708
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 72CENSUS: 48DATE:
02/03/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Vanessa Ladaban, Med TechTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 02/03/2026 at 11:00 am., Licensing Program Analyst (LPA) Lori Alexander conducted a Health and Safety inspection in response to a Priority 1 complaint. LPA met with Medication Technician (Med Tech) Vanessa Ladaban and explained the purpose of the visit. Ms. Ladaban notified Administrator Elisabeth Cortes by telephone.

Upon entry into the Assisted Living and Memory Care units, LPA observed eleven (11) residents participating in a Bingo activity and nine (9) residents watching television. Other residents were observed resting in their rooms.

LPA conducted a tour of the facility, including but not limited to residents' bedrooms, bathrooms, common areas, kitchen, and outdoor areas. Hot water temperature measured 97.5 and 94.3 degrees Fahrenheit in two residents' shared bathroom. The facility maintained a seven (7) day supply of non-perishable food and a two (2) day supply of perishable food. Facility staff reported food supplies are ordered on a weekly basis. Refrigerator temperature was observed at 26 degrees Fahrenheit. Resident medications were observed secured and locked in the medication room. The first aid kit was complete. The fire extinguisher was fully charged and last serviced on 04/14/2025.

LIC809-C Continued...

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Lori Alexander-Washington
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/03/2026
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    LIC809-C (Page 2)

    During the inspection, LPA observed the following deficiencies:

    At 11:20 a.m., LPA observed cardboard boxes and bags on the hallway floor.

    At 11:27 a.m., LPA observed the laundry room door open with toxic chemicals, including Shurgard HP and Clorox Bleach, unsecured.

    At 11:32 a.m., LPA observed shower room floors were not clean.

    At 11:33 a.m., LPA observed tile flooring in assisted living resident rooms was cracked and buckled.

    At 12:48 p.m., LPA observed tile flooring in the Memory Care unit was cracked, buckling, and lifting.

    At 12:49 p.m., LPA observed Clorox Bleach unsecured under a cabinet in the Memory Care unit.

    At 12:50 p.m., LPA observed food items in the top freezer were uncovered and not stored in proper food containers.

    At 12:52 p.m., LPA observed oxygen tanks were not stored properly.

    LIC809-C Continued...

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Lori Alexander-Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 02/03/2026 06:48 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 02/03/2026 at 03:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: WALNUT CREEK WILLOWS
FACILITY NUMBER: 075601431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2026
Section Cited
CCR
87309(a)

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87309 Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions...and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:

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Administrator will conduct In-Service training with all staff and submit sign-in sheet to CCLD by POC due date.
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Based on observation, the licensee did not comply with the section cited above by not having Clorox Bleach and Shurgard HP disinfectant chemicals inaccessible to residents in unlocked laundry room and Clorox Bleach under cabinet in memory care unit which poses an immediate health and safety risk to persons in care.
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Immediate Civil Penalty assessed for $500.00
Type B
02/10/2026
Section Cited
CCR87303(a)(1)

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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.

This requirement is not met as evidenced by:
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Administrator will clean flooring and repair flooring in residents rooms and facility and send contractor receipts of repairs and photos to CCLD by POC due date.
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Based on observation, the licensee did not comply with the section cited above by not having shower floors clean, resident bedroom floors repaired with cracks, tile bulkling in assisted living and memory care units which poses an health and safety 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.
Bennett Fong
NAME OF LICENSING PROGRAM MANAGER:
Lori Alexander-Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/03/2026 06:48 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 02/03/2026 at 04:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: WALNUT CREEK WILLOWS
FACILITY NUMBER: 075601431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2026
Section Cited
CCR
87618(b)(E)(I)

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87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. (I) Equipment shall be removed from the facility when no longer in use by the resident.

This requirement is not met as evidenced by:
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Administrator will read regulation, self-certify understanding by submitting self-certification and photos of oxygen tanks secured and/or removed if no longer in use by resident to CCLD by POC due date.
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Based on observation, the licensee did not comply with the section cited above by not having oxygen tanks secured in a stand/wall and removed when resident was discharged or passed away which poses an health and safety risk to persons in care.
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Type B
02/04/2026
Section Cited
CCR87303(e)(2)

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87303 Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

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Administrator will set water temperatures for residents' bathrooms according to regulation and send photos of water temperatures in assisted living and memory care units bathrooms to CCLD by POC due date.
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Based on observation, the licensee did not comply with the section cited above by not having water temperatures maintained at 105-120 degrees F. in residents' shared bathrooms. Water temps measured at 94.3 and 97.5 degrees F. in assisted living memory care units which poses an health and safety 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.
Bennett Fong
NAME OF LICENSING PROGRAM MANAGER:
Lori Alexander-Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2026


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 02/03/2026 06:48 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 02/03/2026 at 05:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: WALNUT CREEK WILLOWS
FACILITY NUMBER: 075601431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2026
Section Cited
CCR
80087(a)

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(a) The facility shall be...in good repair at all times...

This requirement is not met as evidenced by:
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Licensee agreed to submit a detail plan of when they will have the flooring repaired in all residents rooms including but not limited to assised living and memory care units and submit photos of repaired floors to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above by having disrepair flooring in residents rooms with tiles cracked, buckling and lifting which poses a potential health and safety risk to persons in care.

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Type B
02/11/2026
Section Cited
CCR87555(23)

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87555 General Food Service Requirements
(23) All readily perishable foods... shall be stored in covered containers at appropriate temperatures.

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Administrator will remove food a conduct In-Service training with all staff on food storage including but not limited to all perishable foods and send sign in sheet to CCLD by POC due date.
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Based on observation, the licensee did not comply with the section cited above by having food in the freezer uncovered and not in a food container in memory care unit which poses a potential health and safety 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.
Bennett Fong
NAME OF LICENSING PROGRAM MANAGER:
Lori Alexander-Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2026


LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/03/2026
NARRATIVE
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At 2:17 pm., 6+ wheelchairs, walkers, commodes, Hoyer lifts outside behind shed in parking lot

At 2:19pm BEHR full paint bucket, dried up paint bucket, ladders, 8 large tubs of MGDemaGel 62 sitting outside on side of building

At 2:21 broken debris, 2-3 garbage cans, oxygen tank, two folding tables, stacks of Castille/La Rocca materials

At 2:20pm washing machine, tables, brooms, plastics dish pans located outside on side yard

At 2:25 PM cooking oil in a steel contaciner located outside near back door entrance

The above deficiencies were documented on LIC 809D and cited pursuant to the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.

An exit interview was conducted. A copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Lori Alexander-Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
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