<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390312660
Report Date: 01/12/2022
Date Signed: 01/25/2022 03:45:40 PM

Document Has Been Signed on 01/25/2022 03:45 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:VALLEY CAPS ABLEFACILITY NUMBER:
390312660
ADMINISTRATOR:TAMRA HERNANDEZFACILITY TYPE:
775
ADDRESS:178 SOUTH AUSTINTELEPHONE:
(209) 239-5050
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 135CENSUS: 8DATE:
01/12/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tamra HernandezTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Unannounced annual visit made out to this day program on 01/12/2022 by LPA Charlie Yang and was met by the facility designated Administrator, Tamra Hernandez, who was briefly interviewed.
Current census was 8 clients.
This day program maintained an 3:1 ratio for staff to clients.
Tour of this day program was conducted. It was observed that several classroom units were present and utilized at this time.
All rooms designated as classrooms, activity areas, and common areas for client use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the clients at this time.
Office rooms and other areas intended for client use were toured.
It was learned that due to COVID restrictions and guidelines, certain areas were altered to follow the facility mitigation plan for social distancing and follow CDC guidelines.
This LPA observed that ZOOM and other online resources were used to incorporate client participation.
A review of the day program restrooms was conducted.
Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time.
Fire extinguishers, placed throughout this day program, were observed to have been annually inspected on 12/01/2021 by the local fire extinguisher company and in compliance at this time.
Kitchen area was toured in one of the classrooms.
It was observed that there wasn't an oven/stove present since there wasn't any type of cooking or baking done on site at this time. The use of microwaves and a toaster oven were the only methods used to heat and warm up the food of the clients if necessary.
Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the clients at this time.
Exterior grounds of this day program was toured.
Perimeter fence and gates were observed to be functional and in good repair at this time.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: VALLEY CAPS ABLE
FACILITY NUMBER: 390312660
VISIT DATE: 01/12/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Entrances and exits used were observed to be supplied with hand sanitizer and masks at this time.
The following forms and documents were requested by this LPA to be updated and submitted into CCL:

LIC 308
LIC 400
LIC 500
LIC 610

There were no deficiencies observed or cited during today's annual visit.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2