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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312701026
Report Date: 05/13/2021
Date Signed: 05/13/2021 03:41:16 PM

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 CARE 4FACILITY NUMBER:
312701026
ADMINISTRATOR:IVASCU, KRISZTINA SILVANAFACILITY TYPE:
740
ADDRESS:4738 ROBIN CTTELEPHONE:
(916) 586-4713
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: DATE:
05/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kristzina IvascuTIME COMPLETED:
10:40 AM
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Licensing Program Analysts (LPA) Kerry Hiratsuka and Jacob Williams, contacted the facility via telephone due to COVID-19 and pre-cautionary measures. The purpose of this call is conducting an announced prelicensing visit. LPAs spoke to facility representatives Applicant Krisztina Ivascu via Facetime.

This facility has a fire clearance for five non-ambulatory and one bedridden resident. This facility has six private resident areas and no staff bedroom. Because there is no staff bedroom the facility is required to have awake staff at all times. The main entrance opens into a common area. The main common area has sitting, dining, and kitchen. On the left of the main entrance there is a hallway that leads to one resident room that has an exit to the outside, laundry area with locked cabinets, a common half-bathroom, and the door leading to the garage. Past the first hallway on the left is door leading to a resident room. That resident room has a door connecting to the resident room with the resident room that has an exit to the outside for fire safety. At the back of the facility on the left is the largest resident room that has an exit to the outside and a private full bathroom. On the right side of the facility behind the kitchen there is a hallway that leads to three resident rooms and one full common bathroom. The bedroom at the back, right corner has an exit to the outside. The backyard was toured. There is a gate on the same side as the garage.

-Component III orientation was waived by LPA Hiratsuka due to the experience levels of the facility representative. .
-questions applicants had were answered.
-several topics were discussed.

This facility meets all regulations. LPA is going to submit this report to the application specialist for final review.

LPA is going to email a copy of this report to Administrator and Administrator is to sign, and email a copy back to LPA.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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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