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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 04:14:06 PM

Unsubstantiated


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
11/05/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241105092512
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:
04:30 PM
ALLEGATION(S):
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Facility staff are not assisting resident with meeting their bathing needs
Facility staff are not meeting residents dietary need
Facility staff are retaliating against resident due to previous complaint
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 four (4) residents (R) R1, R2, R3, R4, two (2) staff (S) S1, S2, and one (1) witness (W) W1. LPA obtained and reviewed documents including physician’s report, staff schedule, shower schedules, and facility menu.

LIC9099-C Continued...
Unsubstantiated
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 3
Control Number 15-AS-20241105092512
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 staff are not assisting resident with meeting their bathing needs.
Finding: Unsubstantiated

On 11/08/2024, the LPA interviewed W1. W1 stated that their shower is scheduled on Sundays. W1 stated on 11/03/2024 they were scheduled to get a shower in the evening, but they declined because they prefer a certain caregiver that was not scheduled to work. W1 stated that they spoke with S1 to reschedule their shower and was told that they will get a shower the next day. LPA reviewed R1’s physician’s report and the report indicates that R1 needs assistance with bathing.

On 11/08/2024, the LPA interviewed R1, R2, R3 and R4 that stated that they get showers based on the shower schedule two (2) times a week regardless which caregiver is assigned for that scheduled day.

On 11/08/2024, the LPA interviewed S1 that stated the subject resident declined the scheduled shower on 11/03/2024 because they did not want the two (2) scheduled caregivers to give them a shower. S1 stated that they told subject resident that they will try to accommodate them on the following day, but it depends if the caregivers can schedule subject resident’s shower with the residents that are already scheduled.






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 3
Control Number 15-AS-20241105092512
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)

Allegation: Facility staff are not meeting residents dietary need.
Finding: Unsubstantiated

On 11/08/2024, the LPA interviewed W1 that stated that they cannot eat some of the foods that is prepared at the facility kitchen. W1 stated that they have an allergy with their health condition. W1 stated that they have an upcoming appointment with a dietician and R1 mentioned that their diet restriction is vegan. LPA reviewed subject resident’s physician’s report and the report indicates no food restrictions.

Allegation: Facility staff are retaliating against resident due to previous complaint
Finding: Unsubstantiated

On 11/08/2024, the LPA interviewed S1, S2, S3 and S4. S1, S2, S3 and S4 all stated that they do not have any issues with R1.

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: 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 3