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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701223
Report Date: 09/18/2025
Date Signed: 09/18/2025 11:59:37 AM

Document Has Been Signed on 09/18/2025 11:59 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:ARGONAUT CARE HOME, INC.FACILITY NUMBER:
032701223
ADMINISTRATOR/
DIRECTOR:		NGAIMA, MAMAFACILITY TYPE:
740
ADDRESS:860 ARGONAUT DR.TELEPHONE:
(209) 217-1512
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 6CENSUS: 5DATE:
09/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Renae Earl, Facility SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 9/18/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to correct a report that had been mistakenly entered for a different facility. During a previous unannounced visit to this facility on 8/19/2025, the report had been submitted under Facility #032701225, which has a similar name. LPA met with the facility supervisor, Renae Earl (S2), and clarified the purpose of the visit.

*** The report below was incorrectly entered to a different facility ***
Licensing Program Analyst (LPA) Arvin Villanueva arrived at the facility unannounced to follow up on a death of a resident in care. LPA met with staff on duty, Lacreisha Wilson (S1) and explained the reason for the visit. The Licensee, Chukwudi (Patrick) Ikiseh, was notified and gave permission to S1 to sign this report.

Initial observation: Upon arrival, LPA observed (S1) leaving the facility to go to another facility, about two houses away. LPA rang the door bell 3 times before a visitor (V1) answered the door. V1 stated they cannot let LPA come in and stated that the staff on duty had stepped outside for phone call. After 2 to 3 minutes later, S1 arrived back to the facility and LPA was able to enter. LPA observed 4 residents in the living room with V1 visiting a family member. Per interview with S1, S1 was instructed by their supervisor (S2) to go to the other facility down the street to open a door for the delivery person. S1 confirmed that the visitor is not a staff and that no other staff is on duty during this visit. LPA spoke with Licensee, Chukwudi (Patrick) Ikiseh, to inform him of the lack of staff upon arrival. Per Licensee, he was observing the residents through the camera in the living room.

{1}

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ARGONAUT CARE HOME, INC.
FACILITY NUMBER: 032701223
VISIT DATE: 09/18/2025
NARRATIVE
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Regarding the death incident: On December 2, 2024, the facility notified the Department of the death of Resident 1 (R1). Upon notification of the death, the LPA requested and obtained copies of resident and staff records, including but not limited to staff schedule, resident roster, Personnel Report, Physician reports and Needs and Services Plans for residents. In addition to the records already noted, the Department obtained medical records from the acute hospital, interviewed staff, reviewed notes from doctor visits for Resident 1 (R1), and reviewed medical records from the skilled nursing facility R1 was admitted.

Per medical records, it was noted that R1 had a catheter in place. R1 was responsible for the care of the catheter including draining. R1 was independent with most activities of daily living only receiving staff assistance with showers and catheter bag sanitization. R1 was routinely seen by their urologist who did not note any concerns regarding the catheter.

Per staff interviews, blood was observed on 11/4/2024 in R1’s catheter bag. Paramedics were called to assess R1, but R1 refused medical treatment. Blood was observed in the catheter bag again on 11/15/2024 and paramedics called. R1 was treated at the hospital and died on 11/20/24.

The Department also reviewed local fire department records to confirm emergency services were called on 11/4/24 and 11/15/2024. It was unclear if the death of R1 was due to neglect of the facility or R1’s own negligence, therefore the allegation was unsubstantiated.


*** end of report ***

Note that deficiency was cited on 8/19/2025 and facility submitted the plan of corrections.

S2 needed to leave during the visit and gave permission to S1 to sign this report.

Exit interview was conducted and a copy of this report was provided.

{2}

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/18/2025 11:59 AM - It Cannot Be Edited


Created By: Arvin Villanueva On 09/18/2025 at 11:11 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ARGONAUT CARE HOME, INC.
FACILITY NUMBER: 032701223

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/19/2025
Section Cited
CCR
87411(a)

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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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*note: this was cited on 8/19/25 and plan of corrections has been completed.

Per discussion, Licensee will read the cited regulation and submit a letter of understanding; Licensee to submit letter to the Department by POC due date.
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Based on interview and record review, the licensee did not comply with the regulation cited above. Upon arrival at the facility, there were no qualified staff members, except for one visitor who was not authorized to provide supervision to residents in care. This poses an immediate health, safety and personal risks to persons in care.
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Licensee shall ensure a qualified staff is present at the facility at all times to provide supervision to resident in care.


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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Arvin Villanueva
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
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