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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200630
Report Date: 01/04/2023
Date Signed: 01/04/2023 03:20:31 PM


Document Has Been Signed on 01/04/2023 03:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:BYRON PARKFACILITY NUMBER:
079200630
ADMINISTRATOR:JENNIFER MURRAY PASTORAFACILITY TYPE:
740
ADDRESS:1700 TICE VALLEY BLVDTELEPHONE:
(925) 937-1700
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:151CENSUS: 88DATE:
01/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ernesto Navas, Environmental Services DirectorTIME COMPLETED:
02:30 PM
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On 01/04/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a Plan of Correction (POC) visit. LPA met with Ernesto Navas, Environmental Services Director.

They walked through facility and checked all of the 57 ABC rated and the 2 K rated fire extinguishers. All of the fire extinguishers had been serviced and/or replaced in either December of 2022 or January of 2023. This cleared the citation issued 12/27/2022.

No citations were issued.

Exit interview conducted and copy of this report provided via email.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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