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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:37:39 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
09/17/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240917103055
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:
11/26/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elizabeth Cortes, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility does not have sufficient wash cloths
Facility does not provide a variety of food
Facility staff does not treat client with dignity
INVESTIGATION FINDINGS:
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On 11/26/2024 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrator, Elizabeth Cortes to deliver findings of above allegations. LPA explained the purpose of the visit with Administrator.

During the course of the investigation, LPA interviewed seven (7) residents (R) R1, R2, R3, R4, R5, R6, R7, four (4) staff (S) S1, S2, S3, S4, and witness (W) W1. LPA obtained and reviewed documents including September menu and resident roster.

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

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 7
Control Number 15-AS-20240917103055
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: 11/26/2024
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Facility does not have sufficient wash cloths
Finding: Substantiated

On 09/23/2024, the LPA interviewed W1. W1 stated that residents shared with them that there are no towels or wash cloths when residents shower. W1 stated that on 09/05/2024 they observed two (2) towels and one (1) wash cloth in the shower room.

On 09/24/2024, the LPA interviewed R1, R2 and R3. R2 stated that they have their own towels that they brought from their home. R3 stated that the facility does not have towels. R4 stated that the facility has towels, but the towels are small, the washcloths are low in quantity and the towels are ripped and have stains on them.

On 11/08/2024, the LPA observed approximately ten (10) towels in the shower room. The towels appeared thin, stained, and ripped. LPA brought the observation to the S1 and S2. S1 stated that they have more towels that are getting laundered, and they showed LPA new packages of towels in their office. S1 stated that a lot of towels are thrown away because the caregivers use the towels on residents and that they have to throw them away after use.

Allegation: Facility does not provide a variety of food
Finding: Substantiated

On 09/17/2024, LPA interviewed W1. W1 stated that the facility does not follow the posted menu next to the kitchen and that residents are not given fresh fruits, fresh vegetables and constantly given canned vegetables or processed foods. W1 stated that they inquired about cream, sugar, salt, and pepper for the residents with S3 and that S3 said, “if residents want that, they can buy it.”

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

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20240917103055
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: 11/26/2024
NARRATIVE
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LIC9099-C (Page 3)

W1 stated that S3 told them that they tried hiring a new cook, but he did not show up. W1 stated that they explained to S3 that residents have the right to have options and that some residents have dietary needs. W1 stated that S3 said, “residents do not pay her enough to request more.”

On 09/24/2024, the LPA interviewed S4. S4 stated that they follow the menu that was provided from a company that they use. S4 stated that they were expecting a food delivery tomorrow with fresh veggies and watermelon.

On 09/24/2024, the LPA interviewed R1-R7. R1 stated that the food is not good and taste bland; no snacks are offered and that they don’t follow the menu. R1 further stated that they are served a lot of pork, the presentation doesn’t look good and that you don’t know if it’s meat. R2 stated that the food is pretty good, they have had fresh strawberries. R3 stated that the food is ok but could be better. R3 stated that they get snacks, fresh fruits, and veggies. R4 stated that the facility does not serve fresh vegetables and not enough fresh fruits. But sometimes they have served fresh strawberries and bananas. R5 stated that they have not been served fresh fruits and everything comes from Costco. R6 stated that the breakfast is good with eggs, bacon, and sausage. R6 stated, “the food here sucks,” and that they buy their own food. R6 further stated that the fruits are all canned fruit. R7 stated the food is pretty good, yes, they get a variety of foods and that they also get fresh veggies and fruits

On 09/24/2024, the LPA observed bananas, oranges and two (2) watermelons in the food pantry. The bananas were observed with brown spots. Staff stated that they were expecting a food delivery with fresh fruits and other foods.



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

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 15-AS-20240917103055
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: 11/26/2024
NARRATIVE
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LIC9099-C (Page 4)

Allegation: Facility staff does not treat client with dignity
Finding: Substantiated

On 09/17/2024, the LPA interviewed W1. W1 stated that during a visit to the facility on 08/05/2024 they observed a bathroom door wide open, north wing, while a male resident was naked with his bottom facing the door. W1 stated that they closed the door to preserve the resident’s dignity. W1 stated that on this same day they observed a staff member enter the same bathroom to sweep the floor while the caregiver was assisting the male resident to the toilet. W1 stated that they attempted to address their concerns with S3 on 08/22/2024, to which they never heard back from.

W1 stated that on 09/05/2024 they observed staff referring to a resident using the incorrect pronouns. W1 stated that they spoke with subject resident and that they told them that staff “do it all the time,” and that they don’t like how it makes them feel.

On 09/24/2024, the LPA interviewed R1, R3, R4. R1 stated that the caregivers will take off the gown only and you’ll have a diaper on. R1 stated, “I’m not going out there with no clothes” and then the caregiver will place a cover over them. R1 stated that the caregivers are in a rush to give a shower. R3 stated that they’re not always treated with respect and have had words with two (2) of the caregivers. R3 stated that you get little notice for showers and that showers are rushed. R3 stated that the caregivers will cover them with a towel, sometimes a sheet and then push them out to the shower room on a shower chair. R3 stated that the facility is low on staff, but they prefer a female caregiver to give them a shower.

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

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 15-AS-20240917103055
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: 11/26/2024
NARRATIVE
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LIC9099-C (Page 5)

R3 stated that the caregivers don’t know no better when it comes to respecting people’s gender identity. R3 stated that their pronouns are She/Her and that they have told the caregivers, but they sometimes call them Him/He. S2 stated that staff were calling R3 "He" but they asked R3 what did she want to be called and she told them "She." R4 stated that they observed the caregivers taking their roommate (R5) out for a shower and they only had a hospital gown on. R4 stated that R5 wasn’t completely covered and that you can see parts of their thighs. R6 stated that they are covered up when the caregivers give them a shower. But sometimes they will try to shower themselves.

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

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

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20240917103055
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: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
87307(a)(3)(C)
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87307 Personal Accommodations and Services
(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (3) Equipment and supplies necessary for personal care...(C) Clean linen...The quantity shall be sufficient...

This requirement is not met as evidenced by:
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Administrator agreed to purchase towels and send copy of receipts to CCLD by POC due date.
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Based on observation and interview, the licensee did not comply with the section cited above in by not having clean bath towels, hand towels and wash cloths with sufficient quantity for residents in care at all times which poses a potential health, safety or personal rights risk to persons in care.
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Type B
12/30/2024
Section Cited
CCR
87555(b)(17)
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87555 General Food Service Requirements

(b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service...

This requirement is not met as evidenced by:
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Administrator agreed to hire an full-time employee with formal training and send copy of certifications to CCLD by POC due date.
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Based on observation and interview, the licensee did not comply with the section cited above in by not having a full-time qualified employee by formal training responsible for food services 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: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 15-AS-20240917103055
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: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
CCR
87468.1(a)(1)(b)(5)
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87468.1 Personal Rights of Residents in All Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection. (5) Willfully and repeatedly fail to use a resident’s preferred name or pronouns after being informed of the resident’s preferred name or pronouns in a clear manner.

This requirement is not met as evidenced by:
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Administrator agreed to conduct In-Service Training with staff/caregivers and send copy of sign-in sheet to CCLD by POC due date.
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Based on observation and interview, the licensee did not comply with the section cited above in by not according dignity and respect with bathing, showering, toileting, and addressing residents by their preferred names and pronouns 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: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7