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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202124
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:10:57 AM

Document Has Been Signed on 03/08/2024 11:10 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: 59DATE:
03/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Program Director Melissa RamosTIME COMPLETED:
11:15 AM
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On March 8, 2024, Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced Case Management visit and met with Program Director Melissa Ramos.

The purpose of the visit is to deliver an immediate exclusion letter for staff S1. S1 is not allowed to be physically present in this facility (to work and volunteer).

Program Director stated S1 no longer works at the facility. LPA requested a copy of the facility's LIC500 by March 11, 2024.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Program Director Melissa Ramos and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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