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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701382
Report Date: 08/22/2024
Date Signed: 08/27/2024 02:59:24 PM

Document Has Been Signed on 08/27/2024 02:59 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WIDE HORIZONS INCFACILITY NUMBER:
392701382
ADMINISTRATOR/
DIRECTOR:		STELMACK, MONICAFACILITY TYPE:
775
ADDRESS:1032 W YOSEMITE AVETELEPHONE:
(209) 629-8968
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 15CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Monica StelmackTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Announced Prelicensing visit made out to this day program on 08/22/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility Applicant/designated Administrator, Monica Stelmack, who briefly interviewed.
Current census was 3 clients.
This day program was currently seeking vendorization through Valley Mountain Regional Center as well. It was learned that this day program maintained a 5:1 ratio for clients to staff at all times according to its program design.
Tour of this day program was conducted.
It was observed that there was a classroom unit that was present and utilized at this time.
All areas 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 all times.
Fire extinguishers, placed throughout this day program, were observed to have been annually inspected on 10/25/2023 by the local fire extinguisher company, Nor Cal and Company, and in compliance at this time.
Kitchen area was toured.
The use of a microwave was the only method utilized to heat and warm up the food for the clients, if necessary, at this time.
There wasn't an oven or stove unit present at this time.
Food storage unit was reviewed and observed to be functional and in good repair at this time.
Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the clients at this time.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WIDE HORIZONS INC
FACILITY NUMBER: 392701382
VISIT DATE: 08/22/2024
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Exterior grounds of this day program were toured for the rear of this day program.
Rear gate was observed to be functional and in good repair at this time.

A sample review was conducted for the day program client files at this time.
A sample review was conducted for the day program staff files at this time.

There were no deficiencies observed during this Prelicensing visit.

This day program has been found to be in compliance at this time.

Component III was conducted with the day program Applicant at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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