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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700492
Report Date: 11/14/2023
Date Signed: 12/20/2023 09:27:33 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2023 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230724141101
FACILITY NAME:BEYOND HOME CAREFACILITY NUMBER:
194700492
ADMINISTRATOR:PAULINE CLOKEFACILITY TYPE:
300
ADDRESS:7462 NORTH FIGUEROA ST # 202TELEPHONE:
(310) 600-8192
CITY:LOS ANGELESSTATE: ZIP CODE:
90041
CAPACITY:CENSUS: DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Pauline MinanoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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1. Home Care Aides provided care to client(s) and were not assocated to the Home Care Organization.


2. Home Care Organization is operating in a location not licensed by the department.
INVESTIGATION FINDINGS:
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On 11.14.2023, Associate Governmental Program Analyst (AGPA) Megan Vigil arrived at arrived at the business office of Beyond Home Care located at 225 East Broadway Suite 112 Glendale, Ca 91206 at approximately 10:30am regarding the above complaint allegation.

AGPA Vigil met with Licensee, Pauline Minano. Licensee Minano stated have been operating at address 225 E Braodway as of May 2023. The Department Analyst did not clarify an address change fee was required. Licensee Minano did not verify the operating address when a hard copy of the license was received. Licensee was unaware the Guardian roster must be maintained and updated. An initial inspection and consultation were also completed.

Based on AGPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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 2
Control Number 47-HC-20230724141101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME: BEYOND HOME CARE
FACILITY NUMBER: 194700492
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
1796.36 (a)(2)
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1796.36 ...A home care organization … shall comply with all of the following: (2) Maintain all pertinent records of the operation in California at the California office. All records shall be available to review, copy, audit, and inspect by the Department...
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The licensee will mail an updated HCS 200 form along with a check/money order in the amount of $100 in order to initiate the Department’s change of address process. Payment made payable to the CA Department of Social Services and mailed to 744 P Street, M.S. 9-14-90, Sacramento, CA 95814.
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The analyst concluded that the Home Care Organization’s (HCOs) physical address on file was no longer accurate/current and is therefore not a valid physical location for the HCO. This poses a potential health and safety risk to clients in care.
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Type B
11/22/2023
Section Cited
1796.24(b)(2)
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...The department may permit a home care organization applicant or a home care organization licensee...Upon request of the licensee or home care aide applicant, the department shall verify whether the individual has a clearance or exemption that can be transferred pursuant to the requirements...
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Licensee will update the Guardian Roster to match the active Home Care Aide files and will send proof of correction to their assigned Analyst by 11.22.2023.
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Licensee was unaware the Guardian roster must be maintained and updated to reflect active caregiver files.This poses a potential health and safety risk 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: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2