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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000250
Report Date: 02/10/2024
Date Signed: 02/10/2024 02:03:43 PM

Document Has Been Signed on 02/10/2024 02:03 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:
02/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:AttemptedTIME COMPLETED:
02:00 PM
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On 2/10/2024 at 1pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to 3240 W. March Lane in Stockton, CA conduct a health and safety visit. Currently, the facility is undergoing repairs. As a result, some of the clients in care have been relocated temporarily to a hotel at this time.

At 1:15pm, LPA proceeded to the hotel room and knocked on the door several times. There was no answer at the door. LPA inquired information from the front desk and LPA was informed that licensee had extended their stay at this hotel but unable to provide any more details to LPA due to privacy issue. Additionally, front desk staff confirmed that clients' medications are kept in a locked box located at the front desk. LPA contacted licensee Maricor Camero via phone but there was no answer but LPA left a voicemail. LPA then called staff Sherry via phone and LPA inquired on the whereabouts of the clients. Per Sherry, clients in care are out in the community with another staff. Licensing Program Manager (LPM) Liza King was informed of the details of this attempted 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 on today's visit, there are no deficiencies cited during this visit. An exit interview was conducted with Sherry via phone. LPA informed Sherry that a copy of this report will be emailed to licensee for signature and requested for licensee to send back a signed copy of this report to LPA.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2024
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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