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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701154
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:06:54 PM

Document Has Been Signed on 05/18/2022 12:06 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:SHERRY'S RCFEFACILITY NUMBER:
342701154
ADMINISTRATOR:AHUJA, SHERRY V.FACILITY TYPE:
740
ADDRESS:3996 WILDROSE WAYTELEPHONE:
(650) 690-4881
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 6CENSUS: 0DATE:
05/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sherry AhujaTIME COMPLETED:
12:30 PM
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On 5/18/22 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Sherry's RCFE for the purpose of conducting a pre-licensing inspection. LPA met with Licensee, Sherry Ahuja and together conducted a tour of the home. The facility is a single story home located in a residential neighborhood equipped with four bedrooms, two bathrooms, living room, dining room, kitchen and attached garage. LPA observed a pool with required fencing.

LPA and Licensee evaluated the physical plant to ensure the health and safety of future residents. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed a pool located in the back yard with and enclosed fencing that meets regulations. LPA notes that the pool gate is secure and resident access is restricted. LPA observed the facility to be free of odor, clean and in good repair. LPA observed one of the bathrooms still requires a non-slip mat in the shower and grab bars for the shower and toilet. All rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPA measured the water temperature, temperature measured at 119 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents.

Licensee will send pictures of new grab bars and non-slip mats to LPA to ensure the home meets all regulations.

At the time of inspection the facility is not ready to be licensed. Once bathroom changes have been made and the grab bars and mats are in place LPA will approve the facility for licensure. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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