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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700492
Report Date: 01/24/2025
Date Signed: 01/24/2025 11:25:54 AM

Document Has Been Signed on 01/24/2025 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		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 CAREFACILITY NUMBER:
194700492
ADMINISTRATOR/
DIRECTOR:		PAULINE CLOKEFACILITY TYPE:
300
ADDRESS:225 E BROADWAY STE 112TELEPHONE:
(310) 600-8192
CITY:GLENDALESTATE: CAZIP CODE:
91381
CAPACITY: CENSUS: DATE:
01/24/2025
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Pauline MinanoTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On January 24, 2025, Enforcement Analyst (EA) Adrian Mangina arrived at the facility for the purpose of conducting a Case Management - Deficiencies visit. During the course of a complaint investigation for the complaint submitted on 7/17/24, evidence was gathered which indicated that Ms. Minano (Cloke) had been operating Beyond Home Care as an unlicensed Home Care Organization (HCO from April 25, 2016 through August 29, 2017, when Beyond Home Care was granted a Home Care Organization license by this department.

EA interviewed Ms. Minano who stated that she was in operation at this time and provided business tax documents to support her statement. Ms. Minano also provided names of staff who were employed and payroll amounts, though she could not provide actual payroll records. From other sources, EA obtained invoices and timesheets Ms. Minano had submitted for payment during that time. Based on evidence obtained through interviews and documents received it was determined that Ms. Minano was operating Beyond Home Care without a License from April 25, 2016 through August 29, 2017.

The Analyst informed Ms. Minano wof this deficiency: Title 22, Division 6, Chapter 13, Article 6, Section 1796.35 Unlicensed Home Care Service would be cited on the HCS809-D form.

The licensee was provided a copy of the this report and HCS9058 Appeal Rights form via email

LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 01/24/2025 11:25 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/24/2025 at 06:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 01/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2025
Section Cited
1796.35
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Unlicensed Home Care Services: 1. Subject to the exceptions set forth in Section 1796.17, an individual, partnership, corporation, limited liability company, joint venture, association, or other entity shall not arrange for the provision of home care services by a registered home care aide to a client in this state before obtaining a license pursuant to this chapter. This shall be deemed “unlicensed home care services.”…individual or entity is in violation of subdivision (a), the department shall send a written notice of noncompliance…assess a civil penalty of nine hundred dollars ($900) per day for each calendar day…(b)…individual or entity is in violation of subdivision (a), the department shall send a copy of the written notice of noncompliance to the individual or entity and to the Attorney General or appropriate district attorney or city attorney.(b)…the Attorney General, district attorney, or city attorney may do any or all of the following: (1) Issue a cease and desist order…remain in effect until the individual or entity has obtained a license.. If the individual or entity fails to comply with the cease and desist order within 20 calendar days, the Attorney General, district attorney, or city attorney may apply for an injunction.
2. Bring an action against the individual or entity under Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code. Through evidence obtained and interviews conducted, the business is operating as a HCO without a license. This poses an immediate Health and Safety risk to persons in care.
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This requirement is not met as evidenced by:
Based on the information obtained and interviews conducted ,Beyond Home Care was operating as an HCO without an active license, between 4/25/2016 and 8/29/2017 which poses an immediate Health and Safety risk to persons 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.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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