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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000250
Report Date: 02/12/2024
Date Signed: 02/12/2024 05:53:04 PM

Document Has Been Signed on 02/12/2024 05:53 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:
02/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Sherry Camero, staff on dutyTIME COMPLETED:
06:00 PM
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On 2/12/2024 at 5:24pm, 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.

During this visits, 2 clients in care are watching TV with their staff on duty and one in their bedroom. Per staff, they extended their stay as the construction of the care facility is still ongoing. Medications are still being kept in a locked box at the front desk. LPA observed the residents rooms 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. Sleeping arrangement remains the same: each client have their own bed and night staff utilize a sleeping cot. The residents were observed to be in overall good health. LPA interviewed clients and informed LPA that they are fine.

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: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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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