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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701026
Report Date: 11/15/2024
Date Signed: 11/15/2024 11:10:11 AM

Unsubstantiated


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
09/25/2024 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20240925143949
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:
11/15/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Krisztina Ivascu TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Not enough staff to meet resident's needs
Staff cannot communicate with resident
INVESTIGATION FINDINGS:
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On 11/15/2024 Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak, made an unannounced visit to the facility and met with Administrator Krisztina Ivascu. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the administrator and staff. LPA reviewed the following documents: Resident list, staff list with telephone numbers, admission agreements, care plans, care tracking, Physicians report.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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 59-AS-20240925143949
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: 11/15/2024
NARRATIVE
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Allegation: Not enough staff to meet resident's needs: Unsubstantiated

R1 moved in on during the weekend. R1 does not have a responsible party or any local family. R1 was extremely combative towards care staff. Per R1s LIC602 they are non-ambulatory but can state their own needs and is a one person assist. After reviewing R1’s LIC602 and interviews with the staff, it is determined that R1 can bare weight during transfer and is not a 2 person assist. During interviews it was revealed that there is one care staff on the weekends and two care staff during the week. In interviews with staff LPAs learned that if needed on the weekends other care staff are available to assist.

Allegation: Staff cannot communicate with resident: Unsubstantiated

During the relocation into the facility R1 had not received their updated medications and was having behavioral breakdowns. During this time, R1 was speaking in Romanian and the caregivers were unable to communicate with the resident. While opening the complaint the resident was on updated medication and was able to communicate clearly and in English to LPAs and staff. During interviews with staff it was revealed that staff and R1 are able to clearly communicate with one another.

Based on LPA's observations and interviews, the department has found the complaint allegations to be unsubstantiated, meaning that the although the allegations may have happened or are valid, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated.

Exit interview conducted and a copy of the report and appeal rights were emailed to the Administrator. LPAs printer was not working.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC9099 (FAS) - (06/04)
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