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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701356
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:57:10 PM

Document Has Been Signed on 03/14/2024 03:57 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:SHERRY'S RCFE LLCFACILITY NUMBER:
342701356
ADMINISTRATOR:AHUJA, SHERRY V.FACILITY TYPE:
740
ADDRESS:10609 CHARBONO WAYTELEPHONE:
(650) 690-4881
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 6CENSUS: 5DATE:
03/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sherry AhujaTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a prelicensing visit. LPA Moleski met with applicant Sherry Ahuja and explained the purpose of the visit.

LPA Moleski conducted Component III orientation with Ahuja.

LPA Moleski toured the facility with Ahuja and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Ahuja is still working on correcting deficiencies recorded on 3/5/24, including replacing window screens, and associating staff to the new facility roster. LPA Moleski observed holes in a backyard deck.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locking cabinet for the storage of medication. LPA Moleski observed locking cabinets for the storage of cleaning solutions and knives.

Deficiencies were observed based on citations issued on 3/5/24. Ahuja said corrections would be made within a week. An exit interview was held and a copy of this report was left with Ahuja.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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