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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
312701026
Report Date:
04/19/2022
Date Signed:
04/19/2022 01:58:39 PM
Document Has Been Signed on
04/19/2022 01:58 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 CARE 4
FACILITY NUMBER:
312701026
ADMINISTRATOR:
IVASCU, KRISZTINA SILVANA
FACILITY TYPE:
740
ADDRESS:
4738 ROBIN CT
TELEPHONE:
(916) 586-4713
CITY:
ROCKLIN
STATE:
CA
ZIP CODE:
95677
CAPACITY:
6
CENSUS:
4
DATE:
04/19/2022
TYPE OF VISIT:
Post Licensing
UNANNOUNCED
TIME BEGAN:
01:50 PM
MET WITH:
Administrator Andrei Dumitriu
TIME COMPLETED:
02:10 PM
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Post Licensing visit is conducted in today's inspection.
No deficiencies are cited.
See 809 for Annual visit for 04/19/22 for details.
Exit interview done and copy of the report left at facility.
SUPERVISOR'S NAME:
Laura Munoz
TELEPHONE:
(916) 263-4743
LICENSING EVALUATOR NAME:
Talwinder Bains
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE:
04/19/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/19/2022
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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