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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000250
Report Date: 02/16/2024
Date Signed: 02/20/2024 07:41:34 AM

Document Has Been Signed on 02/20/2024 07:41 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:MELMAR'S GUEST HOME #2FACILITY NUMBER:
397000250
ADMINISTRATOR:CAMERO, MARICORFACILITY TYPE:
735
ADDRESS:6801 MONTAUBAN AVENUETELEPHONE:
(209) 683-6876
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 6CENSUS: 3DATE:
02/16/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Maricor CameroTIME COMPLETED:
06:00 PM
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On 02/16/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to 3240 W. March Lane, Stockton CA to conduct a Health and Safety Visit. LPA was greeted by Administrator, Maricor Camero. Currently, this facility is undergoing major renovations and the residents have been relocated at this time.

LPA observed 3 residents in the hotel. LPA took a tour of the facility.
LPA observed medication in a locked safe located in the hotel room. LPA observed the residents beds were observed to be clean and sanitary. Main area for resident use was toured and the furniture intended for resident use was observed to be in good repair at this time. LPA observed food supply to be sufficient to meet the residents needs at this time. Staff are able to prepare food for the clients as the hotel is equipped with kitchenette complete with stove top and microwave. There are two residents on a bed while another one utilize a sleeping cot. The residents were observed to be in overall good health. LPA informed the administrator to update the Regional Office of any changes.

The department will continue to monitor the situations with health and safety checks until the residents are able to return to their primary residence.



Based observations during this visit, there are no deficiencies cited during this visit. An exit interview was conducted with staff Sherry and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2024
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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