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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201218
Report Date: 02/13/2024
Date Signed: 02/13/2024 05:32:37 PM


Document Has Been Signed on 02/13/2024 05:32 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: DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator Ricardo RomeroTIME COMPLETED:
05:30 PM
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On 02/13/2024 at 3:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a required annual inspection. LPA explained the purpose of the visit to Administrator (ADM) Ricardo Romero.

LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining areas, restrooms, community living spaces, bathrooms, trash areas, and the grounds of the facility. The facility was appropriately furnished and well lit. Professional grade equipment was installed and maintained for residents' care. Food supplies were checked and observed to be sufficient and new orders come on a regular basis. Facility has emergency lighting. Medications are centrally stored and an adequate amount of first aid supplies were on hand. A complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council and Rights to Family Council were observed posted in a prominent location. Fire extinguishers were last serviced on 12/22/2023. The pool was appropriately fenced and secured. Temperature in the facility was measured at 72.8 degrees in the dining room at 4:55 PM.

No citations issued during inspection.

Required Annual Inspection incomplete. LPA shall return unannounced to complete the inspection at a later date and time.


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: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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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