<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005317
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:56:46 PM

Document Has Been Signed on 02/10/2023 12:56 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: 50DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Program Director Erica Ervin TIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a annual/required visit. LPA met with Program Director Erica Ervin and explained the purpose of the visit.

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 & Program Director Erica Ervin toured/inspected 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.

Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 06/20/2022. LPA observed toxins and sharp knives kept locked and inaccessible to clients. First aid kit was checked and is complete.


There were no deficiencies found during today’s visit. Exit interview held with Program Director Erica Ervin and a copy of report was given.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
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)
Page: 1 of 1