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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700676
Report Date: 05/27/2022
Date Signed: 05/27/2022 05:22:04 PM


Document Has Been Signed on 05/27/2022 05:22 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:SILVANA SENIOR CAREFACILITY NUMBER:
312700676
ADMINISTRATOR:KRISZTINA SILVANA IVASCUFACILITY TYPE:
740
ADDRESS:4748 ROBIN CTTELEPHONE:
(916) 586-4713
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 5DATE:
05/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:10 PM
MET WITH:Andrei Dumitriu, AdministratorTIME COMPLETED:
05:40 PM
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Licensing Program Analyst (LPA) Michael Hood met with Administrator, Andrei Dumitriu, to conduct an inspection.

During inspection, LPA observed a staff member not wearing a mask while on the premises. LPA provided technical assistance regarding staff not wearing masks while on the premises.

Exit interview was conducted with Administrator. A copy of this report was provided. The Administrator’s signature on this form acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022
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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