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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700719
Report Date: 11/15/2023
Date Signed: 11/28/2023 04:18:13 PM

Document Has Been Signed on 11/28/2023 04:18 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 95DATE:
11/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Sherry Welker-LozaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced Case Management visit today at the facility. LPA was following -up on multiple incident reports regarding aggressive acts by Consumers/Clients against Staff and other residents.

During visit LPA Johnson reviewed records for R1, R2, R3 and R4 and interviewed the Administrator and Program Director about events related to aggressive acts and resident's program plans including IPP (Individual Program Plan) and behavior intervention plans .

The program has updated the service plans were needed and reported information as required.

No deficiencies were cited during this visit.


Exit interview held.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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