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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201307
Report Date: 11/14/2025
Date Signed: 11/14/2025 04:36:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250528104443
FACILITY NAME:BEYOND CARE HOMESFACILITY NUMBER:
079201307
ADMINISTRATOR:SAGASTUME, KARLAFACILITY TYPE:
735
ADDRESS:124 MADORA PLACETELEPHONE:
(510) 513-3911
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 2DATE:
11/14/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Karla SagastumeTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee illegally evicted resident
INVESTIGATION FINDINGS:
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On 11/14/2025 at 8:30 a.m., Licensing Program Analyst (LPA) A Gomez arrived unannounced to continue the complaint investigation in regard to the allegations above and deliver findings. LPA met with Caregiver, Michael Girard and explained the purpose of the visit. Administrator arrived at approximately 9:45am and had to later leave for an appoint. Approved caregiver to sign report.

During the visit LPA returned to interview Administraror and deliver findings.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 15-AS-20250528104443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BEYOND CARE HOMES
FACILITY NUMBER: 079201307
VISIT DATE: 11/14/2025
NARRATIVE
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LPA obtained copies of eviction letter issued to client 1 (C1) and C1's responsible party. LPA observed that an eviction letter dated 5/18/2025 was addressed to the responsible party for C1. The eviction letter cited Incomplete admission documentation, lack of essential medical information, interference with the facility's ability to coordinate care..., disruption to the emotional stability of other residents/staff, and determination that the client's needs can no longer be met within the scope of the facilities program.

On 11/14/2025 LPA conducted an interview the Licensee. During the interview the Licensee reported challenges with communicating and collaborating with C1's responsible party and stated that issuing an eviction for C1 was the best course of action. LPA reviewed the reasons listed in the eviction letter and determined that the stated causes are not supported under applicable regulation. LPA also observed that A Needs and Services Plan modification was not performed to determined that the client's needs cannot be met by the facility therefore the allegation Licensee illegally evicted resident is Substantiated.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.


Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250528104443

FACILITY NAME:BEYOND CARE HOMESFACILITY NUMBER:
079201307
ADMINISTRATOR:SAGASTUME, KARLAFACILITY TYPE:
735
ADDRESS:124 MADORA PLACETELEPHONE:
(510) 513-3911
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:6CENSUS: 2DATE:
11/14/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Karla SagastumeTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff mismanaged client's medication
Resident sustained unexplained injury while in care
Staff did not report incident to resident's responsible party
INVESTIGATION FINDINGS:
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On 11/14/2025 at 8:30 a.m., Licensing Program Analyst (LPA) A Gomez arrived unannounced to continue the complaint investigation in regard to the allegations above and deliver findings. LPA met with Caregiver, Michael Girard and explained the purpose of the visit. Administrator arrived at approximately 9:45am and had to later leave for an appoint. Approved caregiver to sign report.

During the visit LPA returned to interview Administraror and deliver findings.

Report continues on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20250528104443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BEYOND CARE HOMES
FACILITY NUMBER: 079201307
VISIT DATE: 11/14/2025
NARRATIVE
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On the allegation "Staff mismanaged client's medication" the following was found: On 11/14/2025 LPA reviewed the MAR and centrally stored log for C1 for the entirety of their stay at the facility. LPA observed that the centrally stored matched the MAR and that no dosages of medications were missed. LPA was unable to physically count the medication due to C1 no longer residing at the facility. Therefore the allegation "Staff mismanaged client's medication" is Unsubstantiated.

On the allegations "Resident sustained unexplained injury while in care" and "Staff did not report incident to resident's responsible party" the following was found: LPA received photos of the alleged injury C1 sustained and observed that the injuries appeared superficial and possibly self inflicted. LPA also reviewed records and observed an SIR dated 5/16/2025 that coinsides with C1's injuries. According to the SIR submitted C1 was observed with injuries after an outing with their responsible party. SIR also shows that CCLD, Case Manager, and C1's responsible party were notified. Therefore the allegations "Resident sustained unexplained injury while in care" and "Staff did not report incident to resident's responsible party" are Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250528104443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BEYOND CARE HOMES
FACILITY NUMBER: 079201307
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2025
Section Cited
CCR
80068.5(a)
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(a)Except for children's residential facilities, the licensee may, upon 30 days written notice to the client, evict the client only for one or more of the following reasons:

The following requirement was not met as evidence by:
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By POC Licencee agrees to review regulation and notify CCLD
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Based on record review and interview C1 was evicted for reasons not listed as applicable and a A Needs and Services Plan modification was not done to determine that the facility could not meet the clients needs which is a potential personal rights violation to clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5