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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005317
Report Date: 02/13/2025
Date Signed: 02/13/2025 03:54:17 PM

Document Has Been Signed on 02/13/2025 03:54 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/
DIRECTOR:		ERICA ERVINFACILITY TYPE:
775
ADDRESS:730 MCHENRY AVETELEPHONE:
(209) 576-1918
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 105CENSUS: 75DATE:
02/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Program Director Sam Mcmenomy TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst, Jason Lund arrived unannounced to conduct a case management visit regarding the Unusual Incident/Injury Report (LIC624) dated 2/10/25. LPA Lund met with Program Director Sam Mcmenomy and explained the reason for the visit. Census: 75

It was reported to the day program that client (C1) on 2/10/2025 reported to R&D Transportation that another client had touched C1 during transportation from program to home date is unknown. The day program notified Modesto PD police report # MP250420168. Modesto PD interviewed C1 and came to the conclusion that was inclusive. Adult Protected Services and also spoke with C1 and came to conclusion that was inclusive.

Exit interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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