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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005317
Report Date: 11/19/2021
Date Signed: 11/19/2021 03:38:21 PM

Document Has Been Signed on 11/19/2021 03:38 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:OPEN DOOR SERVICES, INC.FACILITY NUMBER:
507005317
ADMINISTRATOR:ERICA ERVINFACILITY TYPE:
775
ADDRESS:730 MCHENRY AVETELEPHONE:
(209) 576-1918
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 105CENSUS: 53DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Staff Erica ErvinTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 11/19/2021. LPA met with Staff Erica Ervin and explained the purpose of the visit. Erica Ervin is Program Director.

This facility is an adult day program single story building licensed to serve six (105) ambulatory clients of which 10 may be non-ambulatory. LPA toured the physical plant including but not limited to two client bathrooms and 2 client activity rooms, and outside activity area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed the facility kitchen area. Hot water temperature was measured at (116.6) degrees Fahrenheit in bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 06/10/2021. Thermostat observed at (71) degrees Fahrenheit. LPA observed toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.

The following forms need updating and were received during today’s visit on 11/19/2021:
LIC 308, LIC 500, LIC 610. The Day program will send a copy of the certificate of liability insurance to LPA by 11/22/2021.

There were no deficiencies found during today’s visit. Exit interview held with Erica Ervin and a copy of report given at the conclusion of the visit.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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