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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701224
Report Date: 03/30/2023
Date Signed: 03/30/2023 03:08:26 PM

Document Has Been Signed on 03/30/2023 03:08 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 2FACILITY NUMBER:
032701224
ADMINISTRATOR:IKISEH, CHUKWUDIFACILITY TYPE:
740
ADDRESS:840 ARGONAUT DR.TELEPHONE:
(209) 268-0597
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 6CENSUS: 5DATE:
03/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sylvester OkoroTIME COMPLETED:
03:15 PM
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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 Administrator Chukwidi "Patrick" Ikiseh, 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 #1. Observed there are 5 residents in care at this time. The facility is vendorized with Valley Mountain Regional Center (VMRC). According to Licensee Sylvester, there are no regional center residents in care at this time. Chukwidi "Patrick" Ikiseh will be the designated Administrator for this facility. Certificate #6064223740

LPAs toured the facility to ensure compliance of Title 22 regulations. LPAs observed the facility to have 5 residents in care. LPA’s observed the kitchen area, dining area, bedrooms, bathrooms, garage, and office. Bedroom #1 has necessary signage posted at the front door of the bedroom. The facility had enough perishables for a minimum for 2 days and non-perishables for a minium of 7 days. Facility bathrooms were equipped with necessary furniture and furnishings. Medications, cleaning supplies, and toxic items were locked away and inaccessible to residents in care.

LPAs observed the garage area. It was observed to have an emergency supply of food/water. There was a locked away and inaccessible to residents in care. privacy curtain along with old mattresses and a couch. According to staff interviews, this is used for staff breaks. According to the facility sketch, the garage is not a designated staff area. Licensee stated he will remove the items from the previous licensee. There is also a locked area on the side of the home. They do not have key to it; however, there is a shed. According to the Administrator, this is also the property of the previous owner.

Pre-Licensing is incomplete with deficiencies to be resolved by04/07/23. 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)
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