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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624064
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:39:10 PM

Document Has Been Signed on 06/05/2024 01:39 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GROCE, SHERRYFACILITY NUMBER:
343624064
ADMINISTRATOR/
DIRECTOR:		SHERRY GROCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 450-9105
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Sherry GroceTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christopher Bello met with licensee, Sherry Groce, regarding an Unusual Incident that took place May 30, 2024. LPA made observations, gathered documents pertaining to the incident and conducted interviews.

Further investigation is needed.

No Title 22 Deficiencies observed in the areas that were evaluated. A notice of site visit was given and must remain posted for 30 days. Exit
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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