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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002967
Report Date: 07/01/2024
Date Signed: 07/01/2024 09:51:53 AM


Document Has Been Signed on 07/01/2024 09:51 AM - 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:MELINDA'S CARE HOMEFACILITY NUMBER:
347002967
ADMINISTRATOR:MUNAR, MELINDAFACILITY TYPE:
740
ADDRESS:8216 COTTONBALL WAYTELEPHONE:
(916) 761-1150
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 0DATE:
07/01/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Melinda MunarTIME COMPLETED:
10:15 AM
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On 7/1/24 at 9:20pm, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Case Management inspection to gather additional information regarding potential facility closing. LPA met with Administrator and Licensee to clarify the facility position.

LPA confirmed there are currently no residents in placement at the time of inspection.

Facility Licensee confirmed they wish to close the facility. LPA requested and obtained the license from the licensee. LPA provided Licensee with CCLD facility closure survey and licensee agreed to fill out the survey. LPA also requested a letter from the LLC stating the facility is closing. Per the licensee, they are looking more at retirement and wanted to reduce their workload.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024
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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