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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009518
Report Date: 01/27/2025
Date Signed: 01/27/2025 05:12:52 PM

Document Has Been Signed on 01/27/2025 05:12 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FORCELLA, SHERRIE FCCHFACILITY NUMBER:
483009518
ADMINISTRATOR/
DIRECTOR:		FORCELLA, SHERRIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 425-1289
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 23CENSUS: 11DATE:
01/27/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:25 PM
MET WITH:Licensee Sherrie ForcellaTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the home to conduct a plan of correction visit. Licensee was issued a deficiency on 01/06/2025 for not documenting a conducted disaster drill within the last 6 months. The last disaster drill documented was 01/12/2024, licensee had reported there was a disaster drill conducted in winter of 2024, but had not documented it. Licensee conducted a fire drill and documented it 01/21/2025 at 04:00PM with 11 children present.

While LPA was at the home, the licensee showed LPA an updated LIC 9040 facility roster accurately reflecting the children enrolled in the day care. LPA reminded licensee to transcribe children immunization on Blue CDPH 286.

Remaining Deficiencies issued on 01/06/25 have been cleared as of 01/27/25. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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