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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701356
Report Date: 04/04/2024
Date Signed: 04/04/2024 09:55:58 AM

Document Has Been Signed on 04/04/2024 09:55 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:SHERRY'S RCFE LLCFACILITY NUMBER:
342701356
ADMINISTRATOR/
DIRECTOR:		AHUJA, SHERRY V.FACILITY TYPE:
740
ADDRESS:10609 CHARBONO WAYTELEPHONE:
(650) 690-4881
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 6CENSUS: 6DATE:
04/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sherry AhujaTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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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.

During an tour of the facility with staff, LPA Moleski opened the medication cabinet and observed that it was unlocked. Staff searched for the key but were not able to immediately produce it. S1 said S1 was busy cleaning. S2 was preparing food in the kitchen. Neither were passing medications upon arrival.

LPA Moleski observed two staff rooms left unlocked. LPA Moleski and Ahuja observed medications present in both rooms.

S1 moved all resident medications into a separate locking cabinet during this visit.

A citation was issued to the licensee at this address in a separate report. Deficiencies as described above were observed during this visit. LPA Moleski will return for a follow up visit at a later date to reassess compliance.

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: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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