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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342701356
Report Date:
04/25/2024
Date Signed:
04/25/2024 03:18:27 PM
Document Has Been Signed on
04/25/2024 03:18 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 LLC
FACILITY NUMBER:
342701356
ADMINISTRATOR/
DIRECTOR:
AHUJA, SHERRY V.
FACILITY TYPE:
740
ADDRESS:
10609 CHARBONO WAY
TELEPHONE:
(650) 690-4881
CITY:
RANCHO CORDOVA
STATE:
CA
ZIP CODE:
95670
CAPACITY:
6
CENSUS:
6
DATE:
04/25/2024
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:
Sherry Ahuja
TIME VISIT/
INSPECTION COMPLETED:
03:25 PM
NARRATIVE
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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 toured the facility and did not observe any deficiencies. LPA Moleski observed locked cabinets for medication.
LPA Moleski has no objections to licensure. 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:
04/25/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/25/2024
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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