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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701223
Report Date: 05/04/2023
Date Signed: 05/04/2023 04:47:27 PM

Document Has Been Signed on 05/04/2023 04:47 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ARGONAUT CARE HOME, INC.FACILITY NUMBER:
032701223
ADMINISTRATOR:OKORO, SYLVESTER O.FACILITY TYPE:
740
ADDRESS:860 ARGONAUT DR.TELEPHONE:
(209) 217-1512
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 6CENSUS: 4DATE:
05/04/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Facility StaffTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson arrived to the facility unannounced to conduct a continued Pre-Licensing Inspection. LPA Valerio and LPA Viarella conducted an initial pre-licensing inspection on 03/30/23 where there were multiple areas of concern. Licensee and Administrator were to address the areas of concern and ensure compliance of Title 22 regulations. LPM Richardson requested staff to call Licensee/Administrator Sylvester of LPA and LPM arrival. According to staff, Licensee Sylvester was not available to meet due to being out of town and not being told about the visit and co-licensee Patrick was also out of town. LPM Richardson informed that CCL conducted unannounced visits.

The facility had 4 residents in care with 2 staff on shift. LPA and LPM observed the facility physical plant. The facility shed was observed to have a bunk bed with clean sheets, a garage with 2 couch beds with a privacy curtain and a closet with a new lock, and 2 staff on shift. LPA and LPM observed a staff member in the garage behind the curtains. Staff stated they were resting. Interviews with staff stated the beds and privacy curtains were there for resting only and not sleeping.

Facility files were reviewed. Staff files were not up to date and had missing necessary documentation. There were training files in Staff 1 (S1) files. S1 had 2 certificate of completions located in S1 file where a name a different name had been whited out and had S1 name on the certificate. If you turn over the paper, you can visibly see another person's name on the certificate.

Pre-Licensing is incomplete with deficiencies. The licensee did not complete deficiencies that were needed to pass the facility for pre-licensing inspection. LPA and LPM to deliver findings to CDSS Centralized Application Bureau. An exit interview was held with co-licensee Chukwidi "Patrick" Ikiseh via cell phone, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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