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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701390
Report Date: 11/26/2024
Date Signed: 12/02/2024 01:08:57 PM

Document Has Been Signed on 12/02/2024 01:08 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
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:
11/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:31 AM
MET WITH:Jean Hamilton and Merrick HamiltonTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 11/26/2024 at 8:30 AM, Licensing Program Analysts (LPAs) Pang Lee and Holly Williams arrived announced to conduct a follow up Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPAs 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.

LPAs Lee and Williams observed cameras, five outside the building and six inside the facility. Licensee/Administrator marked all cameras on the facility sketch and labeled the cameras as C on the sketch. LPAs Lee and Williams advised that the cameras cannot be facing the residents rooms, or have audio. Licensee/Administrator stated that it is in their plan of operation from the first submission of their application.

  • Licensee/Administrator will ensure to unclutter and clean out the miscellaneous/hazards in the courtyard. COMPLETED
  • 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. COMPLETED
  • Licensee/Administrator will ensure that the physical plant is consistent with the submitted facility sketch/floor plan. COMPLETED
  • Licensee/Administrator will ensure that all resident bathtubs/showers have a non-skid mat. COMPLETED
  • Licensee/Administrator will ensure that there is sufficient shade and setting in the courtyard for 14 residents. COMPLETED

A Component III was completed at this time with the Applicant. The applicant has passed the pre-licensing component of the application process. LPAs Lee and Williams will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. 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: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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