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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701026
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:48:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2022 and conducted by Evaluator Talwinder Bains
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220307135328
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: 4DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
04:17 PM
MET WITH:Andrei DumitriuTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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Staff is not following public health mask requirement.
INVESTIGATION FINDINGS:
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On 03/17/22, during interview with administrator, administrator stated that he was under the impression that with the new guidelines, fully vaccinated and boosted staff for Covid-19, were not required to wear a mask inside the facility. LPAs advised the administrator that this information is not correct and wearing of face mask still required inside the facility despite vaccination status and exemption.
LPAs observed during 03/17/22 visit that staff were not wearing masks while caring for residents in care.

Due to interview conducted with administrator and LPAs' observation during 03/17/22 visit, per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 809-D page.

Exit interview was conducted with Administrator and a copy of this report and appeal rights were provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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 2
Control Number 25-AS-20220307135328
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2022
Section Cited
CCR
87470(a)(5)
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Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:
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Administrator will conduct an in-service training for staff regarding COVID-19 precautionary measures, including proper face covering practices and screening. Facility will submit to LPA information regarding training, including time and date of training and training material, by POC due date 05/27/2022
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During inspection conducted by CCLD on 3/17/2022, LPAs observed staff not wearing face masks while inside the facility, which poses a potential health, safety, and personal rights risk to the residents 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.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2