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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610262
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:17:52 PM

Document Has Been Signed on 11/01/2022 12:17 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ARGOSI HOMES LLCFACILITY NUMBER:
197610262
ADMINISTRATOR:HORNE, TONYFACILITY TYPE:
740
ADDRESS:37654 LANDON AVENUETELEPHONE:
(310) 339-6930
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 4CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tony HorneTIME COMPLETED:
12:20 PM
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On 11/01/22 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an announced Pre-licensing Inspection. Upon arrival, LPA met with Administrator Tony Horne. This is an application for an Adult Residential Facility and has been approved for a total capacity of four (4) clients. Fire clearance has approved bedrooms three (3) and for four (4) for ambulatory clients. The facility is a two-story home with three (3) bedrooms and three (3) bathrooms.

Living Room/Dinning Area: LPA observed the living room and furniture to be clean and in good repair. No firearms observed or will be maintained on the premises. Facility will always maintain a land line in the facility for clients use.

Den: Den has a fireplace with appropriate covering. The facility maintains a comfortable temperature of 71 degrees F and has a functional air conditioner.

Kitchen: LPA observed the kitchen area to be clean and clutter free. LPA observed appliances to be in good repair. LPA observed a startup of food for two (2) day perishable and seven (7) days non-perishable. Sharps and where medication will be stored were observed to be locked and inaccessible to residents in kitchen pantry. Trash can contain a tight-fitting lid. Appropriate plates and cups were observed. No chemicals will be stored in the kitchen area. LPA observed the dining area to be clean and in good repair. First aid kit was observed with all the appropriate requirements. The fire extinguisher was observed to be with a full charge.

Bedrooms: Facility has three (3) bedrooms of which all will be used for clients. One (1) out of the three (3) bedrooms will be a shared and two (2) out of the three (3) bedroom will be for single use. All bedrooms were toured and observed with appropriate furniture, bedding and lighting. The smoke alarm and carbon monoxide detector were operational and tested at 10:40 a.m.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARGOSI HOMES LLC
FACILITY NUMBER: 197610262
VISIT DATE: 11/01/2022
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Bathrooms: Facility has three (3) bathrooms designated for client’s use. Bathrooms were toured and were observed to have trash cans with tight fitting lids. Hot water was tested and measured between 105 and 120 degrees F. LPA observed sufficient towels and wash cloths for clients.

Garage: Facility has a garage that is accessible through the den. Garage will be used for storage and chemicals will be kept locked in the garage. LPA observed laundry area to be clean and clutter free. Washer and Dryer appeared to be in good repair.

Outside: LPA observed appropriate outdoor furniture with a shaded area for clients. There are no bodies of water.

No deficiencies were observed during today's visit.



Component III was conducted during the visit.

This report will be sent to the Centralized Application Bureau (CAB) You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB analyst. Failure to comply could affect the approval of your license.


Exit interview conducted and report issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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