Community Care Licensing

Document Has Been Signed on 07/24/2024 05:17 PM - It Cannot Be Edited

FACILITY NAME:	YOUTOPIA LIVING LLC		FACILITY NUMBER:	079201314
ADMINISTRATOR/ DIRECTOR:	DZHUDZHO, IMIR		FACILITY TYPE:	740
ADDRESS:	1240 PLUMLEIGH LN		TELEPHONE:	(925) 451-8141
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY: 6		CENSUS: 2	DATE:	07/24/2024
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Imir Dzhudzho, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

Link to Parent Document Below:

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2024

Type B

Section Cited

CCR

87411(f)

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having health screening and TB test for S2 which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain S2's health screening and TB test results. Administrator will submit a copy to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

Link to Parent Document Below:

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2024

Type B

Section Cited

HSC

1569.69(a)(2)

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having current medication training for S2 which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain medication training for S2 and will submit a completion documents to CCLD by POC date.

Type B

Section Cited

CCR

87458(b)(5)

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having an updated LIC602 for R2 which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain an updated LIC602 for R2 and will submit a copy to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

Link to Parent Document Below:

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2024

Type B

Section Cited

HSC

1569.695(c)

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not completing a disaster drill which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to conduct a disaster drill and submit document to CCLD by POC date.

Type B

Section Cited

CCR

87411(c)(1)

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having current first aid training for S1 which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain first aid training for S1 and submit completion documents to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
	VISIT DATE: 07/24/2024

Link to Parent Document Below:

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2024

Type A

Section Cited

CCR

87303(e)(2)

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having hot water at 127.8 degrees F which poses an immediate health and safety risk to persons in care.
	POC Due Date: 07/25/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to lower hot water and submit picture proof of new temperature to CCLD by POC date.

Type A

Section Cited

CCR

87465(c)(2)

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by not having R2's Lactobacillus combo and Multivitams available which poses an immediate health and safety risk to persons in care.
	POC Due Date: 07/25/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain the two medications ordered by R2's doctor and submit picture proof to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024

Link to Parent Document Below:

FACILITY NAME: YOUTOPIA LIVING LLC	FACILITY NUMBER: 079201314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2024

Type B

Section Cited

HSC

1569.625(b)(1)

(b) (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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having initial training completed for S2 which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/07/2024
	Plan of Correction
1 2 3 4	Administrator has agreed to obtain initial training for S2 and submit completion documents to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024