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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201218
Report Date: 12/06/2024
Date Signed: 12/06/2024 01:30:27 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
12/04/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20241204151019
FACILITY NAME:BYRON PARKFACILITY NUMBER:
079201218
ADMINISTRATOR:RICARDO ROMEROFACILITY TYPE:
740
ADDRESS:1700 TICE VALLEY BLVDTELEPHONE:
(925) 937-1700
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:151CENSUS: 76DATE:
12/06/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Assistant Executive Director Iryn MacamayTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Wrongful eviction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/06/2024 at 10:00 AM, Licensing Program Analysts (LPAs) James Sampair and David Doidge arrived unannounced at the facility to complete the investigation of the allegation above. Upon entry, the LPAs explained the purpose of the visit to Assistant Executive Director (AED) Iryn Macamay.

The complaint alleges a wrongful eviction of Resident R1.
The LPAs reviewed R1 documentation and interviewed Witness W1, the AED, and Assisted Living Director Graciela Canseco. The data collected shows that R1 requires a higher level of care than the facility can provide.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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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