390312660-1-22-2026-27-AS-CYAG-DQKMXT-20260122090027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390312660
Report Date: 01/21/2026
Date Signed: 01/22/2026 09:00:42 AM

Document Has Been Signed on 01/22/2026 09:00 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	VALLEY CAPS ABLE		FACILITY NUMBER:	390312660
ADMINISTRATOR/ DIRECTOR:	TAMRA HERNANDEZ		FACILITY TYPE:	775
ADDRESS:	178 SOUTH AUSTIN		TELEPHONE:	(209) 239-5050
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY: 135		CENSUS: 33	DATE:	01/21/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Leticia Zendejas and Tamra Hernandez		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 01/21/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility representative, Leticia Zendejas, and was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Tamra Hernandez, to inform her that CCL was present at this time. Mrs. Hernandez arrived shortly thereafter to this day program while this LPA was conducting this annual visit. Current census was 33 clients. This day program was currently vendorized through Valley Mountain Regional Center. It was learned that this day program maintained an 3:1 ratio for clients to staff at all times. 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. 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 12/02/2025 by the local fire extinguisher company, Jorgensen and Company, and in compliance at this time. Kitchen area was toured in one of the classrooms. The use of microwaves and a toaster oven were the only methods used to heat and warm up the food for the clients if necessary. Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VALLEY CAPS ABLE	FACILITY NUMBER: 390312660
	VISIT DATE: 01/21/2026

NARRATIVE

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clients at this time.
Exterior grounds of this day program were toured.
Perimeter fence and gates were observed to be functional and in good repair at this time. Garden area was observed to be fenced off and not in use at this time due to the present weather conditions.
Staff break room/area was toured.

A review of (5) day program clients was conducted and noted on the following LIC 858.
A review of (5) day program staff was conducted and noted on the following LIC 859.

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

The facility designated Administrator, Tamra Hernandez, did supply this LPA with the updated forms as mentioned above at the time of this visit.

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

Exit Interview

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC809 (FAS) - (06/04)

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