<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701225
Report Date: 03/30/2023
Date Signed: 03/30/2023 03:44:09 PM

Document Has Been Signed on 03/30/2023 03:44 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 3FACILITY NUMBER:
032701225
ADMINISTRATOR:NGAIMA, MAMAFACILITY TYPE:
740
ADDRESS:10575 RIDGECREST DR.TELEPHONE:
(209) 268-0597
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 6CENSUS: 2DATE:
03/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Sylvester OkoroTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Christina Valerio and LPA Kim Viarella arrived to the facility unannounced to conduct a pre-licensing inspection. LPAs met Licensee Sylvester and facility staff, and explained the purpose of the visit. The facility is currently going through a change of ownership.

The facility has a fire clearance for 5 non-ambulatory residents and 1 bedridden resident in bedroom #3. Observed there are 2 residents in care at this time. Mama Ngaima will be the designated Administrator for this facility. Certificate #6064142740 Exp. 10/05/24. LPA requested the LIC 500 for the facility to be sent to LPA Valerio by 03/31/23. According to Licensee, today is Administrator Mama day off as she was not present for the facility walk through.

LPAs toured the facility to ensure compliance of Title 22 regulations. The facility did not to have an adequate supply of perishables for a minimum of 2 days and non-perishable foods for 7 days. The facility did not have an emergency supply of food. Pictures were obtained for reference. According to the Licensee, today is shopping day and staff are currently out shopping. This poses an immediate health and safety risk to residents in care. It was observed that the facility staff had raw chicken marinating on the stove top. This is a potential health and safety risk to residents in care.LPAs observed the facility to have sharps, cleaning items, and medications locked and inaccessible to residents in care.

LPAs observed the garage to have a privacy divider located on the left side of the garage. Behind the privacy curtains were mattresses, an area to hang clothes, and a drawer. According to the licensee, no one uses this space. This poses an immediate health and safety risk to residents in care.

Pre-Licensing is incomplete with deficiencies to be resolved by 04/07/23. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies."
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1