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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201314
Report Date: 04/03/2024
Date Signed: 04/03/2024 12:25:28 PM

Document Has Been Signed on 04/03/2024 12:25 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:YOUTOPIA LIVING LLCFACILITY NUMBER:
079201314
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		DZHUDZHO, IMIRFACILITY TYPE:
740
ADDRESS:1240 PLUMLEIGH LNTELEPHONE:
(925) 451-8141
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 0DATE:
04/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Imir Dzhudzho, AdministratorTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 04/03/2024 at 09:55am, Licensing Program Analyst (LPA) Carol Fowler conducted an announced pre-licensing inspection and met with Imir Dzhudzho, Administrator and Caregiver Zhasmin Dzhudzho. Facility has a fire clearance for five (5) non-ambulatory and one (1) bedridden.

LPA toured the facility including but not limited to residents bedrooms, bathrooms, dining room, common living area, kitchen, garage, and backyard. There is sufficient lighting around the facility. Residents rooms are equipped with the proper furniture, lighting, and have proper bedding and linens. Bathrooms were equipped with grab bars and non-skid mats. All toxins and sharp objects are locked. Passageways and hallways are free of obstruction. Fire extinguisher was last serviced on 12/04/2023. Smoke detectors/ Carbon Monoxide detector are in operating condition during visit. Hot water temperature is measured at 120 degrees Fahrenheit. Emergency Disaster Plan was last posted on 01/06/2024. First aid kit was observed to be complete.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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