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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700719
Report Date: 08/25/2023
Date Signed: 08/25/2023 11:32:10 AM

Document Has Been Signed on 08/25/2023 11:32 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: 102DATE:
08/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Sherry Welker-LozaTIME COMPLETED:
11:45 AM
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On 8-25-23 at 10:02am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to conduct a case management visit regarding a resident to resident altercation reported on 8-1-23. LPAs met with Program Director Sherry Welker-Loza and explained the purpose of the visit. LPAs reviewed incident report dated 8-1-23 with program director. Based on record review, it was determined that on 8-1-23 at approximately 12:05pm, resident1 (R1) experienced a behavioral episode in which R1 struck R2 on the left side of R2s forehead with a closed fist and bit R2 as well. Basic first aid was applied by facility staff as appropriate due to a minor scratch. Behavior intervention was applied and both residents were separated. Incident was reported to licensing department, ombudsman, and local law enforcement as required.

During today's case management, LPAs discussed with program director additional interventions and resources due to previous resident to resident altercations and behavior episodes reported to the department. LPAs also reviewed current staff training documents. Program Director confirmed day program is currently implementing and has agreed to continue the following: (1) Staff training on trigger behaviors, (2) Crisis intervention training, (3) Updating plans of care for consumers who exhibit new or worsening behavior episodes, (4) On-going behavior charting, and (5) Continued 1:3 staffing ratio for increased supervision. Program director is made aware of that LPA may continue additional visits to monitor behavior charting and other staff training documentation.

As a result of today's case management, no citations are issued today. An exit interview was conducted with Sherry Welker-Loza and a copy of this report was provided to Sherry.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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