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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 03/05/2025
Date Signed: 03/05/2025 05:40:32 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
02/24/2025 and conducted by Evaluator Lori Alexander-Washington
COMPLAINT CONTROL NUMBER: 15-AS-20250224153947
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: 53DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lynette Sandoval, Administrative AssistantTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not provide a resident with privacy while in care.
INVESTIGATION FINDINGS:
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On 03/05/2025, at 10:30 am, Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct initial 10-day complaint visit and deliver for the above allegation. LPAs met with Administrative Assistant, Lynette Sandoval, and explained the reason for the visit. Lynette phoned Administrator, Elizabeth Cortes, to inform.

LPAs obtained: Resident Registry.

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

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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 3
Control Number 15-AS-20250224153947
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: 03/05/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff did not provide a resident with privacy while in care.
Finding: Substantiated

On 3/03/2025, LPA interviewed Witness (W). W1 stated that on 02/17/2025 while Resident (R), R1, was taking a shower and asked Staff (S), S1, to go to their room and get their "grabbers." W1 stated that R1 has a camera in their room and later observed that S1 picked up R1's phone and was looking at their phone.

On 03/05/2025, LPAs interviewed R1. R1 stated that on 02/17/2025 they asked S1 to go get their "grabbers" from their room while they were taking a shower. R1 stated that they viewed video footage from an App on their phone of S1 picking up their phone and looking at their phone while they were in the shower.

On 03/05/2025, LPAs interviewed S2. S2 stated that R1, sent them a video showing S1 picking up R1's phone and confirmed that the person in the video was S1 in R1's bedroom. S2 stated that they observed S1 picking up R1's phone and scrolling through the phone while R1 was not present in the room. LPAs also viewed and observed S1 in the video picking up a phone, looking at the phone, grabbed the grabbers and walked out the room.

On 03/05/2025, LPAs interviewed S1 via phone call. S1 stated that they do not have any knowledge of picking up R1's phone and looking at the phone. S1 stated that they have no knowledge of anyone else picking up R1's phone and looking at it while they were not present.

Based on LPAs observations and interviews which were 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), are being cited on the attached LIC 9099D.

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

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250224153947
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: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights...87468.1, Personal Rights of Residents in All Facilities,...residential care facilities for the elderly shall have all of the following personal rights:
(1) To have a reasonable level of personal privacy in accommodations...

This requirement is not met as evidenced by:
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Administrator agrees to conduct In-service training with all staff on personal rights including but not limited to phones devices. Training-sign in sheet and synopsis of the training topic will be submitted 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 violating R1's personal rights to privacy including but not limited to picking up R1's phone and looking at messages when they are not present which poses a potential 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: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3