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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701225
Report Date: 07/03/2023
Date Signed: 07/03/2023 12:34:16 PM

Document Has Been Signed on 07/03/2023 12:34 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: 5DATE:
07/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Chukwidi "Patrick" Ikiseh TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Christina Valerio and LPA Arvin Villanueva arrived to the facility unannounced to conduct a continued pre-licensing inspection. LPAs met with facility staff Chukwidi "Patrick" Ikiseh, and explained the purpose of the visit, which was to determine if plan of corrections have been cleared.

On 03/30/23, the department made an initial visit and found the below deficiencies. The Department conducted a subsequent visit on 05/04/23, which deficiencies were not cleared. On 05/05/23, the Department held an office meeting via Microsoft Team with current licensee Arvin Gomez to discuss deficiencies. The Department conducted a subsequent visit on 05/15/23 and discovered that the facility did not clear the deficiencies. On 06/20/23, the Department conducted an office meeting via Microsoft teams with current licensee and pending licensee Sylvester Okoro to discuss plan of corrections. Based on today's observations, the deficiencies have been cleared.
· Type B: 87411(c )(1) Personnel Requirements - General
· Type A: 87411(g) Personnel Requirements - General
· Type B: 87207 False Claims
· Type A: 87465(h)(2) Incidental Medical and Dental Care
· Type B: 87555(b)(9) General Food Service Requirements
· Type A: 87202(a) Fire Clearance
· Type A: 87309(a) Storage Space

Administrator Patrick was informed that staff are not to use the garage as a break room. If licensee would like to change to a break room, a updated facility sketch would need to be submitted along with an updated fire clearance. Failure to comply with the above statement, in addition to Title 22 regulations, could lead to further action by the Department and/or can lead to citations. An exit interview was held, and a copy of the report was provided. LPA to notify the Department that the "Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete."
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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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