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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201218
Report Date: 01/04/2023
Date Signed: 01/04/2023 03:15:00 PM

Document Has Been Signed on 01/04/2023 03:15 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:
079201218
ADMINISTRATOR:MURRAY, JENNIFERFACILITY 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ernesto Navas, Environmental Services DirectorTIME COMPLETED:
03:30 PM
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On 01/04/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a change of ownership prelicensing visit. LPA met with Ernesto Navas, Environmental Services Director.

This inspection began with a POC visit to clear the citation for fire extinguishers that did not pass inspection (refer to 12/27/2022 LIC 809-D for facility #79200630). The 809-D for facility #79200630 was cleared during that inspection.

No citations issued during visit.

Pre-Licensing is complete and this facility has no deficiencies.

Final review of application and license to be granted by Centralized Application Bureau analyst.

Exit interview conducted and copy of this report provided via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
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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