312700676-8-16-2021-25-AS-LMUZ-C6837Y-20210824180039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700676
Report Date: 08/16/2021
Date Signed: 08/16/2021 03:43:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2021 and conducted by Evaluator Praveen Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210414152518

FACILITY NAME:	SILVANA SENIOR CARE		FACILITY NUMBER:	312700676
ADMINISTRATOR:	KRISZTINA SILVANA IVASCU		FACILITY TYPE:	740
ADDRESS:	4748 ROBIN CT		TELEPHONE:	(916) 586-4713
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	6	CENSUS: 5	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Tomar Reid, Direct Care Staff		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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-Resident was injured by another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced visit with Direct Care Staff Tomar Reid to deliver findings on the above allegation. Prior to this visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

This complaint allegation was accepted by the Department's Investigations Branch (IB) as a full investigation. The Department reviewed records and conducted interviews. Based on the information gathered there was not sufficient evidence to substantiate neglect and/or lack of supervision resulting in R1 sustaining injuries.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Administrator Krisztina Silvana Ivascu over the phone and a copy of this report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 236-4743
LICENSING EVALUATOR NAME: Praveen Singh	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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