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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701223
Report Date: 09/30/2026
Date Signed: 09/30/2026 02:18:39 PM

Document Has Been Signed on 09/30/2026 02:18 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ARGONAUT CARE HOME, INC.FACILITY NUMBER:
032701223
ADMINISTRATOR/
DIRECTOR:		SHADAE JAMESFACILITY TYPE:
740
ADDRESS:860 ARGONAUT DR.TELEPHONE:
(209) 217-1512
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 6CENSUS: 5DATE:
09/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Andeta Smart, DesigneeTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 09/30/26.  LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the Designated Facility Administrator. LPA learned that that Administrator of record, Shadae James did not have an active Administrator certificate. This deficiency was cited on the LIC 809D page. LPA met with Designee, Andeta Smart. LPA had emailed a list of documents (below) to be collected during this visit. These documents included:
  • LIC 500: Personnel Report; please update and remove any staff no longer employed and include all new hires in Guardian. To associate someone to your facility, submit your fingerprint transfer to sactranfserrequest@dss.ca.gov.
  • A copy of your Resident/Client Roster
  • LIC 308: Designation of Administrative Responsibility
  • LIC 309: (for any LLC or Corp) if applicable
  • LIC 402: Surety Bond, if applicable
  • LIC 610E: Emergency Disaster Plan
  • Copy of Liability Insurance
  • An updated lease agreement, if applicable.
  • An updated Facility Sketch

LPA compared the LIC 500 to the Guardian roster to ensure that all staff had the required background clearances. All were in compliance at the time of this inspection.
Lisa Rios
Kimberly Viarella
DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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Document Has Been Signed on 09/30/2026 02:18 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 09/30/2026 at 12:14 PM
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: 09/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(1)
Other Provisions
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2026
Plan of Correction
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The Designee stated that the licensee will ensure that an audit is conducted of staff files is conducted and a tracking sheet with be used to show what has been done and what still needs to be covered. These tracking sheets will incuded all topics listed in the regulations (with hours or training and trainor inclued) as well as tracking of the hands-on training as outlined in the regulations. This informaiton will be emailed to Kimberly.viarella@dss.ca.gov.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2026


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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: 09/30/2026
NARRATIVE
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The LPA inspected the kitchen.  All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable.

LPA inspected 4 resident rooms. All had the required furniture, furnishings and lighting to be in compliance at the present time.

LPA inspected a total of 2 resident bathrooms.  Each contained soap, paper towels, trash cans with lids and grab bars as required. Showers had non-skid surfaces for safety purposes.

The 2 fire extinguishers (1 in the kitchen, 1 in the garage) were last serviced on 07/15/26 by Sierra Foothill Service Fire Extinguisher Company and were in compliance at the time of inspection.
 
The LPA observed medications were stored in a locked closet near the primary resident bathroom and inaccessible to residents in care. LPA observed bins for each of the current residents along with an extra bin that contained pre-poured weekly pill organizers for 3 of the 5 residents in care. This deficiency has been cited on the LIC 809D page.  LPA reviewed storage, dosing, and destruction procedures with Designee. LPA informed the Designee regarding the requirement for over-the-counter medications like Tylenol to have prescriptions on file.  A review of the First Aid kit by the LPA found it to be complete and in compliance.

The exterior of the building was inspected by the LPA. The yard accessible to the residents in care was well maintained and in good repair. There were sitting areas in shaded locations for residents and their guests to enjoy. In a separate locked area, there was an in-ground pool that was covered, completely fenced in, locked and inaccessible to residents in care. LPA observed that two of the sliding door screens off the back of the house were in need of repair as well as one rear window and one window on the left side of the house. LPA also observed that there were sheds built onto the side of the left side of the home that had doors that were falling off. The gutters to those sheds were overflowing with moss and debris. This deficiency has been cited on the LIC 809D.

LPA conducted a review of 2 resident files. LPA provided consulting regarding the difference between an LIC 602 and an LIC 602A. LPA also reviewed 2 staff files. Both were missing documentation regarding training. This deficiency was cited on the LIC 809D page.

LPA reviewed the LIC 500 schedule of staffing and observed that the Administrator listed was scheduled to
NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2026 02:18 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 09/30/2026 at 12:45 PM
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: 09/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when this LPA observed 2 slider screen doors in need of repair, 1 rear window screen, 1 left side window screen, the shed doors on the left side of the building and the gutters on the shed which were filled with moss and debris. These needed repairs poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/30/2026
Plan of Correction
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The Designee stated that the Licensee will make the necessary repairs and send photos to Licensing at Kimberly.viarella@dss.ca.gov by the close of business on 10/30/26.
Type B
Section Cited
CCR
87405(a)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the administrator of record does not have an active RCFE certificate, and when scheduled was not available to supervise staff or attend to administrative duties as there were scheduled from 7:00PM to 7:00 AM alone, or on Sundays. The Licensee also did not ensure that the Designee understood their responsibilities with regard to developing a plans of correction. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2026
Plan of Correction
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The Designee stated that the Licensee will send the required documentation for a change of administrator with an updated schedule by 10/64/26. They will also review how to develop a plan of correction with the Designee and email this LPA stating when they have done so, no later that 10/1426. Documents will be sent to Kimberly.Viarella@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2026 02:18 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 09/30/2026 at 01:13 PM
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: 09/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(5)
Incidental Medical and Dental: Each resident's medication shall be in its orginal container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview with the Designee, the licensee did not comply with the section cited above in 3 out of 3 residents' medications were transferred to pill organizers for a week's worth of medication passes. This poses an potenial health, safety or personal rights risk to persons in care.
POC Due Date: 10/02/2026
Plan of Correction
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The Designee stated that they will not longer pre-pour medications into weekly pill organiizers. The Designee provided this LPA with a declaration stating that they undestand the abvproviden tement deeclaring that they understand this regulation and will no longer pre-pour medications into weekly pill organizers.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2026


LIC809 (FAS) - (06/04)
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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: 09/30/2026
NARRATIVE
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work alone from 7:00 AM - 7:00 PM on Sundays. Administrators are required to staff adequately so that
may be present at the facility to supervise staff and manage the day to day operations during regular business hours. This deficiency was cited on the LIC 809D page.

According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit, a copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with the Designee.
NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC809 (FAS) - (06/04)
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