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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701390
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:34:03 PM

Document Has Been Signed on 11/01/2024 01:34 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 0DATE:
11/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Jean and Merrick HamiltonTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 11/01/2024 at 11:30 AM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA met with applicant, Jean and Merrick Hamilton. This Applicant is seeking licensure for 14 non-ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will not have live in staff and will provide 24/7 care to residents. There were no residents at this time. A brief interview with applicant Jean was conducted.

Jean Hamilton will be the Administrator of this facility. The facility administrator’s certificate # is 7033190740 and will expire on 02/23/2026. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval.

LPA toured the facility and inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. LPA observed sufficient silverware, cups, plates, and utensils to meet the needs of the residents at this time. The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed not sufficient at this time for 14 residents.

LPA observed cleaning supplies and laundry supplies were made inaccessible to the residents at this time and kept locked in the garage. The common area and dining area were observed to be furnished and sufficient to seat and meet the needs of 14 residents at this time.

LPA observed a telephone made available to residents in the common area. The facility smoke detectors and carbon detectors were observed to be in good condition. The facility has two fire extinguishers located in the common area and hallway of the facility. The fire extinguishers were last serviced on 06/21/2024. A Linen closet was observed and had sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. Residents’ bedrooms were toured, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents.

Continued LIC 809-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: UTOPIA ASSISTED LIVING
FACILITY NUMBER: 342701390
VISIT DATE: 11/01/2024
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LPA observed three resident showers did not have non-skid mats. The hot water in resident bathroom measured at 120.0 degrees Fahrenheit. The facility temperature measured at 70 degrees Fahrenheit. LPA observed the centrally stored medication areas to be locked. LPA inspected the first aid kit, and it was complete. LPA observed sufficient supply of hygiene items on the premises made available to residents in care. LPA observed facility has a designated area for residents and staff files, which is kept locked. LPA observe required poster such as Licensing Complaint Poster posted in the facility. LPA did observe activity supplies made available for residents at this time. LPA toured the garage and there was no concern. LPA toured the courtyard and did not observe the courtyard having shade and outside seating made available for residents in care at this time. LPA observed the facility is in the process of putting up new wood fence. LPA Lee observed broken granite pieces from a broken table. LPA Lee also observed multiple screws on the floor. LPA Lee observed a wood sew in the backyard. LPA advised applicant to remove the broken table, screws and wood sew. During today’s inspection, LPA observed the physical plant is not consistent with the submitted facility sketch/floor plan. LPA observed a resident’s bedroom was switched with a staff’s room. Applicant stated that she will discuss with Centralized application Bureau (CAB) regarding the changes in staff and resident’s room.

LPA discussed with the applicant that the following items must be corrected:

· Licensee/Administrator will ensure to unclutter and clean out the miscellaneous/hazards in the courtyard.

· Licensee/Administrator will ensure that the facility have sufficient supplies of 2 days perishable and 7 days non-perishable for 14 residents in care at all times.

· Licensee/Administrator will ensure that the physical plant is consistent with the submitted facility sketch/floor plan.

· Licensee/Administrator will ensure that all resident bathtubs/showers have a non-skid mat.

· Licensee/Administrator will ensure that there is sufficient shade and setting in the courtyard for 14 residents.

The Applicant has not passed the pre-licensing component of the application process. The applicant will correct issues and inform LPA when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the Applicant.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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