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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700719
Report Date: 02/10/2023
Date Signed: 02/10/2023 10:46:22 AM

Document Has Been Signed on 02/10/2023 10:46 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: 104DATE:
02/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sherry Welker-LozaTIME COMPLETED:
11:00 AM
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On 2-10-23 at 10:23am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit. The purpose of today's case management was to amend a citation previously written on 2-7-23. LPA met with Program Director Sherry Welker-Loza and explained the purpose of the visit. LIC 809D has been amended to reflect appropriate resident identity coding and signed for acknowledgement.

An exit interview was conducted with Sherry Welker-Loza and a copy of this report was left with Sherry.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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