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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200630
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:44:12 PM


Document Has Been Signed on 02/01/2023 03:44 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: 89DATE:
02/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cayia HenryTIME COMPLETED:
04:00 PM
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On 02/01/2023 at 12:30 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a Case Management visit. The visit concerned a question Executive Director (ED) Jennifer Pastora asked the LPA during their earlier meeting. It was a question concerning the possible eviction of R1 and R2 due to nonpayment by their POAs, W1 and W2.

In preparation for the meeting, the LPA was able to draw from what the ED had said earlier in the day about the situation. He then reviewed facility documents and the applicable Title 22 regulations.

During the meeting with Assistant Executive Director (AED) Cayia Henry and the ED, the LPA provided information on applicable Title 22 regulations.

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: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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