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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202124
Report Date: 03/01/2024
Date Signed: 03/01/2024 12:20:23 PM

Document Has Been Signed on 03/01/2024 12:20 PM - 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: 62DATE:
03/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Melissa RamosTIME COMPLETED:
12:30 PM
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On March 1, 2024, Licensing Program Analyst (LPA) Manuel Monter and Licensing Program Manager (LPM) Romeo Manzano, conducted an unannounced case management-Incident visit regarding an incident report on 2/29/24 . LPA and LPM introduced themselves and explained the purpose of the visit.

On 02/29/2024, the Department received an incident report stating on February 20, 2024 regarding alleged physical abuse by staff (S1) towards a client (C1).

LPA and LPM interviewed 6 staff and 2 clients (C1 and C2). C1 and 5 staff's files reviewed and made some copies.

This incident needs further investigation.

No deficiencies cited during todays visit. A copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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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