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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:56:58 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
03/03/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250303150627
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:
03/06/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Elizabeth Cortes, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not use food service sanitation practices to protect the resident's food from contamination.

INVESTIGATION FINDINGS:
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On 03/06/2025 at 12:10 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrator, Elizabeth Cortes to deliver the findings of above allegation. LPA explained the purpose of the visit with Administrator/Licensee.

During investigation, LPA obtained the following documents: Resident Roster, Staff Roster, Menus for February and March 2025, care plans for residents on modified diets.


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

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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 6
Control Number 15-AS-20250303150627
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: 03/06/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Staff did not use food service sanitation practices to protect the resident's food from contamination.
Finding: Substantiated

On 03/03/2025, LPA L. Alexander interviewed witnesses (W) W1 and W2. W1 stated that on 02/01/2025 the facility served fish and that the fish was undercooked. W1 stated that the fish was baked, and it was cooked on the outside but when they used their knife to cut into the fish it was uncooked. W1 stated that they returned the meal back to the caregiver. W2 stated that on 02/06/2025, Resident (R), R1, told them that the chicken was raw and that they didn’t eat it. W2 stated that they observed that protective gloves are not worn when preparing meals. W2 stated the meals are not nutritious nor well prepared. Both W1 and W2 stated that lunch and dinner are served at around 11:30am and 4:30pm.

On 03/05/2025, LPAs L. Alexander and K. Nguyen interviewed fifteen (15) residents (R). R6, R9, R13 stated that they have been served raw food before, the food is not good and most times food is served cold. R2, R3, R4, R5, R6, R7, R8, R12, R14 and R15 all stated that the food is not good and is served cold. R9 stated that the food is okay. R11 stated that they’re on a modified diet. Therefore, they haven’t experienced the quality of food temperature and taste of the food served.

On 03/05/2025, LPAs L. Alexander and K. Nguyen toured the kitchen around 11:50 am and observed four (4) staff (S) members in the kitchen preparing food and prepping food on trays to serve the residents. LPAs observed S1 stirring food in a pot with just one (1) glove on and the three (3) other staff were not wearing gloves or protective hair nets while handling food and food trays.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 15-AS-20250303150627
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: 03/06/2025
NARRATIVE
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LIC9099-C (Page 3)

At around 12pm three (3) out of the four (4) staff that were in the kitchen started to place protective gloves on their hands. LPAs observed S2 handling food, then handling paper menus with the same gloves on. At around 4:39 pm LPAs observed three (3) staff members in the kitchen prepping food to serve residents for dinner who were not wearing protective gloves nor hair nets on their heads. LPAs observed two (2) other staff serving dinner plates to the residents in the dining area who were not wearing protective gloves.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/03/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250303150627

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:
03/06/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Elizabeth Cortes, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff retaliated against resident for complaining.
INVESTIGATION FINDINGS:
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On 03/06/2025 at 12:10 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Administrator, Elizabeth Cortes to deliver the findings of above allegation. LPA explained the purpose of the visit with Administrator.

During investigation, LPA obtained the following documents: Resident Roster, Staff Roster, Menus for February and March 2025, care plans for residents on modified diets.


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

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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 6
Control Number 15-AS-20250303150627
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: 03/06/2025
NARRATIVE
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LIC9099-C (Page 5)

Allegation: Staff retaliated against resident for complaining
Finding: Unsubstantiated

On 03/03/2025, LPA L. Alexander interviewed witness (W) W1. W1 stated that on 02/08/2025 they went to the kitchen and knocked on the door three times and on the third knock S2 opened the door with an attitude. W1 further stated that S5 was told by S4 that R1 was not served their lunch tray and that S5 said “I don’t care.” W1 stated that it feels like retaliation from some of the staff caregivers. W2 stated that they felt retaliation if they complain about something.

On 03/05/2025, LPAs interviewed R2. R2 stated that they have heard S4 being rude to R1. R2 stated that R1 yells at staff. R3 thru R15 all stated that they do not have any trouble with the caregiver staff. R3 thru R15 all stated that they get good care from the caregivers and that they have not felt any type of retaliation. R3 thru R15 all stated that they have not heard any of the staff caregivers speak of any residents in a negative way that would suspect retaliation.

On 03/06/2025, LPA interviewed S2. S2 stated that they do not talk to R1 due to previous issues. S2 stated that R1 chooses not talk to with them. S2 stated that S3, S4, S5 and S6 all have expressed frustration because R1 is always complaining to or about them. S2 stated denial of retaliation towards R1 but they just won't be talking to them anymore.

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.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 15-AS-20250303150627
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: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2025
Section Cited
CCR
87555(b)(9)(15)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food...
(15) All persons engaged in food preparation and service...food services sanitation practices which protect the food from contamination.

This requirement is not met as evidence by:
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Administrator agreed to conduct an In-Service Training with staff on personal hygiene and food services sanitation practices which protect the food from contamination. All kitchen staff/cooks shall submit food handler certifications 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 having staff practicing safe food sanitation when preparing and serving food. In addition, serving food that is of good quality, taste and is not cold to residents which poses a potential health, safety or personal rights risk to persons in care.
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Also Administrator agreed to schedule an appointment for a nutritionist, a dietitian, or a home economist to do consultations during meal time at the facility and will send the consultant's report to CCLD through March 2026.
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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: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6