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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201218
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:25:18 PM


Document Has Been Signed on 02/23/2024 03:25 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:RICARDO ROMEROFACILITY TYPE:
740
ADDRESS:1700 TICE VALLEY BLVDTELEPHONE:
(925) 937-1700
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:151CENSUS: 162DATE:
02/23/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Ricardo RomeroTIME COMPLETED:
03:30 PM
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On 02/23/2024 at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to continue the annual inspection that began 2/13/2024. Upon entry into facility, the LPA explained the purpose of the visit to front desk staff and to Administrator (ADM) Ricardo Romero when he arrived at 9:45 AM.

The LPA reviewed facility records and the records of 9 staff members and 8 residents. The LPA interviewed 5 staff members and 5 residents.

Required Annual Inspection complete. No citations issued during inspection.

Exit interview conducted with ADM and a copy of this report provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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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