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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201307
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:55:04 PM

Document Has Been Signed on 12/20/2023 02:55 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:BEYOND CARE HOMESFACILITY NUMBER:
079201307
ADMINISTRATOR:BERRIS, JEAN C.FACILITY TYPE:
735
ADDRESS:124 MADORA PLACETELEPHONE:
(510) 513-3911
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 6CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Berries Jean C., AdminstratorTIME COMPLETED:
03:20 PM
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LPA K. Nguyen conducted a face-to-face Component III presentation on 12/20/23 starting at 2:00 pm. LPA met with licensee and administrator respectively, Karla Sagastume/ Berris Jean C.

LPA presented Component III power point and discussed the regulations embodied in the power point. LPA observed the two participants gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conducted and copy provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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