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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004947
Report Date: 11/15/2024
Date Signed: 11/19/2024 01:41:49 PM

Document Has Been Signed on 11/19/2024 01:41 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:VALLEY CAPS PLUSFACILITY NUMBER:
397004947
ADMINISTRATOR/
DIRECTOR:		TAMRA HERNANDEZFACILITY TYPE:
775
ADDRESS:1180 N. UNION ROADTELEPHONE:
(209) 239-5050
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 75CENSUS: 48DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Angela Baca and Rachelle MunozTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Unannounced case management visit made out to this day program on 11/15/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the day program staff person, Program Specialist Angela Baca, at this time. A brief interview was conducted with the facility staff person at this time.
Current census was 48 clients.
The purpose of this case management visit was to follow up on an incident that took place recently around 09/05/2024 involving two individuals, R1 and R2, at that time.
It was learned that there was an alleged incident of possible sexual abuse that might have taken place. After interviews and a review of the day program logs for outings with clients, it was learned that the two individuals were not even present at the same location on the day when the alleged incident took place.
It was learned that this day program followed the required steps and procedures, as well as, notified the responsible parties for the individuals and entities too.

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

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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