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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000250
Report Date: 02/20/2024
Date Signed: 02/20/2024 07:51:20 PM

Document Has Been Signed on 02/20/2024 07:51 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: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:
02/20/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:47 PM
MET WITH:M. CameroTIME COMPLETED:
06:55 PM
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On 2/20/2024 at 5:47pm, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to Residence Inn at 3240 W. March Lane in Stockton, CA to conduct a health and safety visit. LPA was greeted by Administrator, Maricor Camero. LPA observed 3 residents in the hotel.

LPA took a tour of the facility at approximately 6:00pm, 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 including ready made meals, microwavable items and snacks to be sufficient to meet the residents needs at this time.



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. All residents and staff went into the lobby to complete the visit.

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 Maricor Camero and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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