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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202124
Report Date: 02/14/2024
Date Signed: 02/14/2024 10:50:38 AM

Document Has Been Signed on 02/14/2024 10:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 CENTERFACILITY NUMBER:
435202124
ADMINISTRATOR:CARMELA MAGPAYOFACILITY TYPE:
775
ADDRESS:1753 SOUTH MAIN STREETTELEPHONE:
(408) 438-0442
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 75CENSUS: 60DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Melissa RamosTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Melissa Ramos. During the visit, ADM stated there are 60 residents and 28 staff.

LPA toured the facility inside out with ADM which included the main activity area and activity rooms, kitchen, dining room, 2 restrooms. The staff area of the facility was also inspected. The outside perimeters of the facility was also inspected. There was no obstruction to block the walkways. During the visit, LPA observed residents doing karaoke in the main activity area. LPA observed cubicles where the clients can store their belongings.

LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 117 degrees F in both the men's and women's restroom. LPA observed toiletries and covers on the trash can.

There were 3 fire extinguishers observed in the facility and were last serviced in August 18, 2023. LPA observed a dual fire alarm system with carbon monoxide detectors which in all areas. ADM stated that the properly landlord does the maintenance every six months.. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 9, 2024. The facility has 16 transportation vans and are all being service at least every 3 months and as need.

LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 1 resident medications and centrally stored medication records. LPA conducted interviews with 3 staff (S1 to S3) and 3 residents (R1-R3).
No deficiencies cited during today's visit. This report was reviewed with Administrator Melissa Ramos and a copy of the signed report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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