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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700676
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:45:00 PM


Document Has Been Signed on 09/26/2023 02:45 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SILVANA SENIOR CAREFACILITY NUMBER:
312700676
ADMINISTRATOR:ANDREI DUMITRIUFACILITY TYPE:
740
ADDRESS:4748 ROBIN CTTELEPHONE:
(916) 824-2025
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 6DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Krystina Silvana IvascuTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/26/23 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with Administrator and explained the purpose of the visit. There are currently Covid positive residents at the facility. LPA wore N-95 mask. File reviews conducted outside.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. PPE supplies present. Staff observed to properly use PPE.

LPA reviewed resident files. Files were complete. LPA and designee discussed resident who receives services from another agency, their continued placement and retaining documents required by the other agency.

LPA reviewed staff files. Files complete for forms and training. Advisory for restricted conditions training to be on file.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted. Report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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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