075601431-10-7-2025-15-AS-BFOG-DMEV4V-20251013160658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 10/07/2025
Date Signed: 10/07/2025 11:37:11 AM

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
10/21/2024 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20241021152551

FACILITY NAME:	WALNUT CREEK WILLOWS		FACILITY NUMBER:	075601431
ADMINISTRATOR:	CORTES, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	2015 MT. DIABLO BLVD.		TELEPHONE:	(925) 256-8708
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	72	CENSUS: 54	DATE:	10/07/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Daffodale Fernandez, Medication Technician		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Lack of care being provided

INVESTIGATION FINDINGS:

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On 10/07/2025 at 8:45 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Medication Technician, Daffodale Fernandez, to deliver the findings of above allegation. LPA explained the purpose of the visit with Daffodale Fernandez. Licensee/Administrator, Elizabeth Cortes wasn't available. Daffodale called Elizabeth Cortes to inform and received approval from Ms. Cortes to sign report. The Administrator arrived approximately 10:16AM.

During investigation, LPA L. Hall obtained the following documents: Resident Roster, Staff Roster. LPA L. Alexander obtained the following documents: R1’s admission agreement, Appraisal, Needs and Services plans (dated 07/25/24, 08/16/24, and 09/30/24), physician’s reports (dated 07/09/24 and 08/15/24), hospice care plan (dated 08/16/24).

LIC9099-C Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20241021152551

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: 10/07/2025

NARRATIVE

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LIC9099-C (Page 2)

Allegation: Lack of care being provided
Finding: Unsubstantiated

On 10/28/24, Licensing Program Analyst (LPA) L. Hall interviewed Witness (W1). W1 stated that Resident 1 (R1) is receiving hospice services and had recently participated in a care conference with Staff 1 (S1). During the conference, S1 explained that the facility is working to establish a baseline for R1. W1 reported there has been no communication between the hospice agency and the facility. W1 stated that R1 told them he often waits 45–90 minutes for staff to respond to his call light. W1 was informed that the call system had been malfunctioning, which caused delays in staff response. R1 also reported that one weekend he was cleared to shower, and his wound dressing became wet. R1 was unsure who authorized the shower and who was responsible for changing the dressing. The following day, the wound area appeared red. W1 expressed uncertainty regarding what type of care the facility staff should be providing to R1.

On 12/16/24, LPA Alexander interviewed W2, who stated that Suncrest Hospice provides services three times a week for wound care, bathing, and dressing R1. However, hospice staff also reported that they visit R1 daily to provide bed baths, and on days hospice does not come, facility caregivers provide R1 with a bed bath. W2 further confirmed that R1 cannot take showers due to wounds on his body. LPA interviewed S1 that stated that R1 was on hospice and that hospice staff provided R1 with a bed bath Monday through Friday, while facility caregivers provided bed baths on weekends. LPA interviewed Residents 2–6 (R2, R3, R4, R5, and R6), who stated that caregivers respond to their rooms and turn off the call lights. The issue regarding wait times for call light response had been substantiated in a prior complaint and was already addressed with the facility.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20241021152551

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: 10/07/2025

NARRATIVE

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LIC9099-C (Page 3)

LPA L. Alexander reviewed R1’s physician’s reports, hospice care plan, and appraisal/needs and services plans. Based on record review and interviews, the evidence demonstrates that facility staff were aware of and providing the services required to meet R1’s care needs. Although concerns were reported regarding communication between the hospice agency and facility staff, response times to call lights, and wound care, there is insufficient evidence to prove or disprove that a lack of care occurred.

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: 10/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

LIC9099 (FAS) - (06/04)

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