342701154-5-26-2023-27-AS-KHOS-CT9KL4-20230629075920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701154
Report Date: 05/26/2023
Date Signed: 05/26/2023 11:50:33 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2023 and conducted by Evaluator Kevin Gould

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230320162518

FACILITY NAME:	SHERRY'S RCFE		FACILITY NUMBER:	342701154
ADMINISTRATOR:	AHUJA, SHERRY V.		FACILITY TYPE:	740
ADDRESS:	3996 WILDROSE WAY		TELEPHONE:	(650) 690-4881
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	6	CENSUS: 4	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sherry Ahuja		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Personal Rights:
1) Staff yell and intimidate residents.
2) Staff threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Sherry's RCFE (RCFE) on 5/26/23 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because all clients interviewed were unable to corroborate the allegations. LPA conducted interviews with two staff members who denied the allegations. LPA interviewed six residents and all residents interviewed identified the staff as treating residents with respect and kindness. LPA was unable to interview one of the alleged victims as their current whereabouts were unknown to the reporting party. LPA was able to interview one of the alleged victims who did not identify any issues concerns during their placement at the facility.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230320162518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SHERRY'S RCFE	FACILITY NUMBER: 342701154
	VISIT DATE: 05/26/2023

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

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