<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601431
Report Date: 10/07/2025
Date Signed: 10/07/2025 11:38:50 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
03/06/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250306135204
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: 54DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Daffodale Fernandez, Medication TechnicianTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not treat resident with dignity and respect
Staff are not serving food of quality to residents
Staff retaliated against resident complaining
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/07/2025 at 9:30 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Medication Technician, Daffodale Fernandez, to deliver the findings of above allegations. 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.

During investigation, LPA obtained the following documents: Resident Registry, Staff Roster, Shower Schedules for North and South Wing Residents.

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)
Page: 1 of 4
Control Number 15-AS-20250306135204
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LIC9099-C (Page 2)

Allegation: Staff do not treat resident with dignity and respect
Finding: Unsubstantiated

LPA interviewed Staff 2 (S2), who denied speaking rudely to Resident 1 (R1). S2 stated they always served R1’s food tray in the dining area and collected trays along with those of the other residents. LPA also interviewed Staff 1 (S1), who stated the facility does not use bleach in the laundry. S1 explained that a commercial laundry system is used to address stains. It was noted that the concern regarding staff treating residents without dignity and respect was substantiated in a prior complaint involving the subject resident and staff, and has already been addressed with the facility.

Allegation: Staff are not serving food of quality to residents
Finding: Unsubstantiated

LPA interviewed R1, R2, R3, R4, and R5. All residents reported that the food served was acceptable. On 03/13/25 and 04/09/25, LPA observed lunch and dinner meals, which included a sandwich on wheat bread, lasagna, mixed vegetables, and wheat bread. The concern regarding food quality was substantiated in a prior complaint and has been addressed with the facility.

Allegation: Staff retaliated against resident complaining
Finding: Unsubstantiated

On 03/13/25, LPA interviewed R1, who stated they did not want S2 to clean their room or provide care. R1 alleged that video footage showed S2 entering their room with Staff 3 (S3) while R1 was absent from the facility. LPA interviewed Staff 4 (S4), who currently works in the kitchen.
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 4
Control Number 15-AS-20250306135204
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 LIC9099-C (Page 3)

S4 denied retaliating against R1 and explained that, due to prior conflicts, they avoid interaction with R1. S4 reported that R1 verbally harassed them, including cursing, making derogatory comments, and threatening to call their family.

S4 further stated that R1 has a special diet but sometimes eats their own food. Staff 1 confirmed that R1 maintains frozen meals for personal use. Regarding laundry, S1 reported the facility uses the “Omni” laundry system with detergent and sanitizer only, and bleach is not used. LPA toured the laundry room and observed no bleach present.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of report was given.
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: 3 of 4
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
03/06/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250306135204

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: 54DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Daffodale Fernandez, Medication TechnicianTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not properly safeguard resident's personal belonging
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Staff do not properly safeguard resident’s personal belongings
Finding: Unfounded

The reporting party did not provide the name of the resident allegedly missing a jacket after receiving two jackets the day prior.

The allegation that “Staff do not properly safeguard resident’s personal belongings” was determined to be Unfounded, meaning the allegation was false, could not have happened, and/or lacked a reasonable basis.

Exit interview conducted and a copy of report was given.
Unfounded
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)
Page: 4 of 4