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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005317
Report Date: 01/31/2024
Date Signed: 01/31/2024 01:22:40 PM

Document Has Been Signed on 01/31/2024 01:22 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: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: 33DATE:
01/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Program Director Erica Ervin TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required visit and met with Program Director Erica Ervin and explained the purpose of the visit. Census: 33

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 04/24/2023. LPA observed toxins and sharp knives kept locked and inaccessible to clients. First aid kit was checked and is complete. LPA Lund reviewed three staff files & three client files which are in compliance.

No deficiencies during today’s visit. Exit interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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