<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201307
Report Date: 11/14/2025
Date Signed: 11/14/2025 04:41:26 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
05/07/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250507130606
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:Caregiver, Michael GirardTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator is threatening eviction
Administrator is restricting resident’s ability to have visitors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 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-20250507130606
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On the allegation "Administrator is threatening eviction" the following was found: LPA reviewed correspondences between Client 1 (C1) responsible party and Licensee and observed that the Licensee did mention finding new placement for C1 due to challenges with communicating and collaborating with C1's responsible party therefore the allegation "Administrator is threatening eviction" is substantiated. LPA has already addressed and cited for the illegal eviction on complaint 15-AS-20250528104443 and will no be reciting.

On the allegation "Administrator is restricting resident’s ability to have visitors" the following was found: LPA reviewed correspondences between Client 1 (C1) responsible party and Licensee and observed that the Licensee did request that C1 not visit for the first 30 days of C1's placement and put it into the admissions agreement. Therefore the allegation "Administrator is restricting resident’s ability to have visitors" 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
05/07/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250507130606

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:Caregiver, Michael GirardTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator did not develop a needs and services plan prior to accepting resident
Administrator interfering with client receiving incidental medical care
Administrator not competent/qualified to fulfill duties.
administrator interfering with conservators responsibilities
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 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-20250507130606
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On the allegation Administrator did not develop a needs and services plan prior to accepting resident the following was found: LPA observed a needs and services plan for C1 dated 4/25/2025. C1 was admitted to the facility 4/26/2025 therefore the allegation Administrator did not develop a needs and services plan prior to accepting resident is Unsubstantiated.

On the allegation Administrator interfering with client receiving incidental medical care the following was found: LPA was unable to identify where the facility was interfering with client receiving incidental medical care. LPA tried reaching out to C1's homehealth nurse to verify if they were ever denied visiting C1 as a part of C1's incidental medical care however LPA was unable to make contact therefore the allegation Administrator interfering with client receiving incidental medical care is Unsubstantiated.

On the allegation Administrator not competent/qualified to fulfill duties. the following was found: LPA observed that the Administrator is currently certified and holds a valid certificate. LPA also interviewed the Licensee who was able to effectively answer questions related to their duties. Therefore the allegation Administrator not competent/qualified to fulfill duties is Unsubstantiated.

On the allegation administrator interfering with conservators responsibilities the following was found: LPA observed that C1's conservator is a limited conservator with rights to make medical decisions for C1. LPA observed on documentation that the facility attempted to make contact with C1's physicians to better be able to assist C1. LPA also observed through emails that C1's conservator was not working collaboratively with the facility to provide care for C1 therefore the allegation administrator interfering with conservators responsibilities is 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-20250507130606
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
85072(b)(4)
1
2
3
4
5
6
7
(b) The licensee shall insure that each client is accorded the following personal rights.
(4) To have visitors, including advocacy representatives, visit privately during waking hours, provided that such visitations do not infringe upon the rights of other clients.

This requirement is not met as evidence by:
1
2
3
4
5
6
7
Licensee has reviewed the regulation and confirms that they understand the clients rights. POC clear.
8
9
10
11
12
13
14
Based on record review the Licensee put in the addmissions agreement for clients not to have visitors in their first 30 days which is a potential personal rights to clients in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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