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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701624
Report Date: 02/05/2026
Date Signed: 02/06/2026 08:42:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2026 and conducted by Evaluator Cynthia Tamayo
COMPLAINT CONTROL NUMBER: 27-AS-20260106112546
FACILITY NAME:BEYOND CAREFACILITY NUMBER:
342701624
ADMINISTRATOR:TIN, ANTONETTEFACILITY TYPE:
740
ADDRESS:9040 CARLISLE AVETELEPHONE:
(916) 549-2724
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:4CENSUS: 4DATE:
02/05/2026
UNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:E Antoniette "Toni" TinTIME COMPLETED:
04:12 PM
ALLEGATION(S):
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Staff did not address resident's change in condition
INVESTIGATION FINDINGS:
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On 2/5/2026, Licensing Program Analyst, Cynthia Tamayo (LPA), arrived unannounced at this facility to close and deliver findings for the complaint investigation regarding the allegation noted above. LPA initially met with staff on duty, Exequiel Allan Fernando (S2). The administrator, Antoniette "Toni" Tin (S1) arived around 3:35PM.

Allegation: Staff did not address resident's change in condition
It was alleged that staff did not address resident's change in condition. This investigation consisted of interviews of facility staff, residents, witnesses interviews, record reviews. On 1/9/26, LPA conducted a visit to the facility. LPA spoke with 2 facility staff who stated they ensure to call 911 if any resident is in need of medical attention. R1 has seizures and they are not sent out to Day Program if they notice they showing signs of being off baseline; in which R1 eats less breakfast, is less talkative, he does not respond to topics he is interested in.
Continued on 809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
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 27-AS-20260106112546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BEYOND CARE
FACILITY NUMBER: 342701624
VISIT DATE: 02/05/2026
NARRATIVE
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Interview with 3 out of 3 residents stated that they have no concerns about the facility nor staff. 2 out of 3 residents were not able to answer questions with full responses. R1 stated they have seizures and do not like going to the hospital. R1 stated their needs and being met and feel safe at the facility. R1 recalls they felt fine before going to day program on 1/2/26 the day in which he was off baseline when he arrived at day program and was sent to the hospital from Day Program. S1, S2, person 1 (P1), Person 2 (P2), and Person 3 (P3), all stated they notice R1 becomes less talkative and unresponsive when he has “episodes” or seizures and sometimes becomes confused or disoriented. P3 reported they noticed R1 is less talkative since moving to this facility and have some concerns over the staff’s ability to address resident's change in condition. P4 does think R1 was already off baseline the morning of 1/2/26.
S2 stated they notice lack of sleep impacts R1’s seizure activity. It was reported R1 wanted to stay up late for new years eve in which they stayed up until 11:00 PM of which they were monitoring R1 closely for seizure warning signs the following days. S1 stated care staff is also trained on what seizure warning signs to look for.

S1 stated IPP and IPP quarterlies are completed on a quarterly basis and will ensure to complete a re-appraisal if there is every a change in condition in between the quarterly care plan development with Alta Regional Center. LPA provided S1 and S2 with guidance on documenting, reporting requirements, immediate emergency treatment in emergency situations, and personal rights per Title 22.

Record review shows the facility is maintaining daily notes to document changes in condition for residents. R1 was sent out to the hospital on 10/12/25,11/3/25, 11/26/25, 12/5/25, and 1/2/25 all due to R1 being off baseline. Based on interviews and observations, there was insufficient evidence to corroborate the allegation, therefore the allegation is unsubstantiated.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.
Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Cynthia Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2