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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701390
Report Date: 10/04/2024
Date Signed: 10/04/2024 12:56:21 PM

Document Has Been Signed on 10/04/2024 12:56 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:UTOPIA ASSISTED LIVINGFACILITY NUMBER:
342701390
ADMINISTRATOR/
DIRECTOR:		HAMILTON, JEANFACILITY TYPE:
740
ADDRESS:5756 WALLACE AVETELEPHONE:
(916) 539-1430
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 14CENSUS: DATE:
10/04/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Jean HamiltonTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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Facility Type: RCFE
Application Type: Initial
Capacity: 14
Census (if any clients in care): none
COMP II Participants: Jean Hamilton
Interview Method: Telephone interview

On October 4, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.
During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program

2. Training/Medications/Activities/ Fire Drill requirements

3. Staffing requirements /screening staff & residents

4. Pre Licensing Inspection readiness

SUPERVISORS NAME: Julia Kim
LICENSING EVALUATOR NAME: Dianne Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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