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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700719
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:51:46 AM

Document Has Been Signed on 03/27/2023 11:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:OPENDOOR SERVICESFACILITY NUMBER:
392700719
ADMINISTRATOR:NAKAWATASE, JOHNFACILITY TYPE:
775
ADDRESS:1129 ENTERPRISE STTELEPHONE:
(209) 475-1529
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 165CENSUS: 103DATE:
03/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sherry Welker-LozaTIME COMPLETED:
12:00 PM
NARRATIVE
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On 3-27-23 at 10:45am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an incident reported on 3-7-23. LPA met with program director Sherry Welker-Loza and explained the purpose of the visit. Incident report and physician's report was reviewed with program director. Incident report states that on 3-7-23 at approximately 2:00pm, resident1 (R1) and his group were in route back to the day program on a city bus. R1 and his group arrived at their schedule bus transfer and R1 remained on the bus unsupervised, which resulted in an absence of supervision. At approximately 3:00pm, R1 notified his care home staff of his location, who in turn notified day program of R1's whereabouts. Day program staff then arrived at R1's location and transported him back to day program.

Day program staff began searching for R1 immediately upon learning of R1's absence of supervision. Day program reported incident accordingly and per regulatory requirements. Physician's Report reviewed states R1 is unable to leave facility unassisted.

As a result of today's case management, citation is issued under Title 22, division 6. An immediate civil penalty in the amount of $500 is issued in addition to the citation due to absence of supervision. An exit interview was conducted with Sherry Welker-Loza and a copy of this report was left with Sherry. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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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Document Has Been Signed on 03/27/2023 11:51 AM - It Cannot Be Edited


Created By: Michael Bilger On 03/27/2023 at 11:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OPENDOOR SERVICES
FACILITY NUMBER: 392700719

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/28/2023
Section Cited
CCR
82078(a)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. This requirement was not met as evidenced by:
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Licensee conducted staff training on appropriate care and supervision and will submit proof of training to LPA by POC due date.

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Based on interview and record review, R1 was alone on a bus, and unsupervised by staff for approximately 1 hour resulting in absence of supervision. This posed an immediate health and safety risk to resident in care.
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Licensee will submit a plan in place to establish appropriate supervision including during bus transfers.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Liza King
LICENSING EVALUATOR NAME:Michael Bilger
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
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