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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701026
Report Date: 04/22/2026
Date Signed: 04/22/2026 10:44:00 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260126132637
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: 6DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Karcia WalkerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility staff did not adequately manage resident’s fall risk
Staff failed to seek timely medical attention for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday April 22, 2026, to deliver findings for a complaint received on 1/26/2026. LPA met with Administrator Karcia and explained the purpose of the visit. Additionally, LPA spoke with Licensee Krisztina on the phone and explained the findings and citations.

During the investigation, the Department conducted interviews and obtained documentation pertinent to the investigation. The result of the investigation is as follows: R1’s facility care plan indicated that they required 24-hour supervision and assistance with all activities of daily living. Per interviews, R1 would refuse to sleep in their bed and would sleep in their recliner instead. Multiple documents indicated that R1 was a fall risk including their appraisal dated 10/21/2025. R1’s plan of care stated they have a history of multiple falls with head injury. R1’s medical assessment dated 10/23/2025 stated R1 has a history of multiple falls. Additionally, hospital records dated 10/17/2025 and 1/2/2026 showed R1 was seen due to multiple falls. S1 and S2 were interviewed and indicated that R1 was a fall risk. The Licensee was interviewed and acknowledged that R1 was a fall risk. However, the investigation determined that there
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 59-AS-20260126132637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SILVANA SENIOR CARE 4
FACILITY NUMBER: 312701026
VISIT DATE: 04/22/2026
NARRATIVE
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were no fall preventative measures in place during the nighttime. S3 was live-in staff and could not provide any information about the care R1 required during the daytime or nighttime. S3 denied checking on residents during the nighttime.

On 1/23/2026, at approximately 1500 hours, staff called 911 for R1 because they were complaining of left hip pain. R1 was admitted to Sutter Roseville Medical Center and diagnosed with a left hip fracture. The hospital contacted facility staff to determine how R1 may have sustained the fractured hip and there were no records of any recent falls. However, there was a text message from S3 to the facility group chat that indicated S3 found R1 on the floor on 1/23/2026 at 0400 hours. S3 placed R1 back in their bed. It was unknown how long R1 was on their bedroom floor prior to S3 finding them. Staff interviews indicated that protocol for unwitnessed falls is to call 911.

Based on interviews conducted and documentation obtained, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached 9099-D page. As a result of the resident's serious bodily injury, an immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 is being assessed for a violation that the Department determines resulted in the injury or illness of a person in care. An additional civil penalty assessment is under review and determination is pending. LPA will return on a future date to assess an additional civil penalty if warranted.

See 9099-D for citations

Exit interview conducted. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20260126132637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SILVANA SENIOR CARE 4
FACILITY NUMBER: 312701026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2026
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4)
87468.2 Additional Personal Rights of Residents . . . (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents . .(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers,
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Facility agrees to submit a plan regarding how the facility will manage resident's supervision during the day and nightime. Included in the plan will be the facility's staffing when resident's are identified as a fall risk.
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qualifications, and competency to meet their needs.This requirement was not met as evidenced by: R1 being documented as a fall risk and not providing adequate supervision which poses an immediate health, safety, and personal rights risk to resident in care.
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Type A
04/23/2026
Section Cited
CCR
87465(g)
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87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health . . . This requirement was not met as evidenced by R1 having an unwitnessed fall and staff not calling 911 for transport and
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Facility agrees to submit training for all staff regarding emergency and 911 protocol.
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evaluation which poses an immediate health, safety, and personal rights risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260126132637

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:
04/22/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Karcia WalkerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Physical abuse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday April 22, 2026, to deliver findings for a complaint received on 1/26/2025. LPA met with Administrator Karica and explained the purpose of the visit. Additionally, LPA spoke with Licensee Krisztina on the phone and explained the report.

During the investigation, the Department conducted interviews and obtained documentation pertinent to the investigation. The result of the investigation is as follows: R1 reported to Sutter Roseville Medical Center staff that ‘someone’ hit them and that ‘staff’ assaulted them. R1 referenced the ‘cook’ hitting them and stated ‘staff’ hit them. Around this time, S3 was identified as being the cook at the facility. R1 did not provide specific names as to who hit or assaulted them. R1’s son reported that R1 claimed they were pushed by ‘staff’ and fell but R1’s story was vague. Staff and other residents were interviewed and denied ever hearing or seeing S3 push or hurt R1. Additionally, S3 denied pushing or hurting R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20260126132637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SILVANA SENIOR CARE 4
FACILITY NUMBER: 312701026
VISIT DATE: 04/22/2026
NARRATIVE
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Based on LPA's interviews, the department has found the complaint allegation to be unsubstantiated,meaning that although the allegation may have happened or is valid, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated.

Exit interview conducted and a copy of the report was provided to the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5