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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202124
Report Date: 09/05/2024
Date Signed: 09/05/2024 09:34:24 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2024 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20240802161419
FACILITY NAME:BEYOND POTENTIAL LEARNING CENTERFACILITY NUMBER:
435202124
ADMINISTRATOR:CARMELA MAGPAYOFACILITY TYPE:
775
ADDRESS:1753 SOUTH MAIN STREETTELEPHONE:
(408) 438-0442
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:75CENSUS: 61DATE:
09/05/2024
UNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Program Director Melissa RamosTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not provide supervision resulting in one of the participant sustaining bruises on the chest.
Facility did not report a possible altercation between two participants to responsible party and to CCLD.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Program Director Melissa Ramos.

On August 2, 2024, the Department received a complaint alleging the facility did not provide supervision resulting in one of the participants sustaining bruises on the chest. It has also been alleged that the facility did not report a possible altercation between two participants to responsible party and to CCL.

On August 8, 2024, and August 28, 2024, LPA Manuel Monter interviewed Clients C1-C11. 8 Out of 11 clients interviewed (C1, C3-C5, C7-C11) were unable to provide answer to LPA’s questions. 2 Out of 10 Clients interviewed (C2, C6) stated they have not seen staff or clients hit C1.
Page 1 Out of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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 26-AS-20240802161419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BEYOND POTENTIAL LEARNING CENTER
FACILITY NUMBER: 435202124
VISIT DATE: 09/05/2024
NARRATIVE
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3
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7
8
9
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On August 8, 2024, LPA interviewed staff S1- S4. 4 Out of 4 staff interviewed stated they did not observe staff or other clients hitting C1.

On August 22, 2024, LPA Monter interviewed Client C1’s Family Member (FM). FM stated C1 does not have self injurious behaviors. FM stated C1 did not have any behaviors or accidents that could have caused the bruises.

Based on a review of C1’s Progress notes dated July 15, 2024, the facility was notified by C1’s family member, that C1 had bruises on his/her chest the week before.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations is UNSUBSTANTIATED. An unsubstantiated finding indicates that although client C1 sustaining bruises is a fact, there is not a preponderance of evidence to prove that the allegations of neglect/lack of supervision did or did not occur.

END OF REPORT

Page 2 Out of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2