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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700719
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:24:30 PM

Document Has Been Signed on 01/10/2024 12:24 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: 90DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Sherry Welker-LozaTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection on 1/10/2024. LPA met with Sherry Welker-Loza explained the purpose of the visit.

The facility is licensed for 165 persons as a behavior management adult day program with a current census of 90. The facility has 4 classroom areas and two outside areas. The facility was providing classroom activities for residents during the inspection. LPA also conducted the infection control domain tool. The facility has an approved COVID Mitigation plan. LPA and Staff inspected the physical plant including but not limited to the kitchen (resident store), resident bathrooms, activity rooms, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was measured at 118.5 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire Marshal visited on 8/28/23 and granted clearance for another year. LPA observed centrally stored medications locked. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 15 resident and 10 staff files, including criminal record clearances. Fire drill was completed on 10/2023. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete.

The facility is in compliance pursuant to Title 22 rules and regulations, Health and Safety Codes.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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