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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201218
Report Date: 12/06/2024
Date Signed: 12/06/2024 03:20:24 PM

Document Has Been Signed on 12/06/2024 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BYRON PARKFACILITY NUMBER:
079201218
ADMINISTRATOR/
DIRECTOR:
RICARDO ROMEROFACILITY TYPE:
740
ADDRESS:1700 TICE VALLEY BLVDTELEPHONE:
(925) 937-1700
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: 151CENSUS: 76DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Assistant Executive Director Iryn MacamayTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 12/06/2024 at 10:00 AM, Licensing Program Analysts (LPAs) D. Doidge and J. Sampair arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with, Iryn Macamay
Assistant Executive Director and explained the purpose of the visit.

LPAs toured the facility including but not limit to, bedrooms, bathrooms, multiple activity rooms, kitchen, and common area. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 78 degrees Fahrenheit. The hot water temperature in a common bathroom was measured at 118.6 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps are locked and inaccessible to residents in care.

The pool was appropriately fenced and secured. Fire extinguisher was last serviced on 12/22/2023. Emergency disaster drill are conducted every other monthly, last conducted on 10/11/2024. First aid kit was observed to be complete.

LPAs reviewed five (5) resident records and five (5) staff records, all were complete.

No deficiencies observed or cited during this visit. .

Exit interview conducted and a copy of this report provided
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
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.

LIC809 (FAS) - (06/04)
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