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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312701026
Report Date: 07/01/2025
Date Signed: 07/01/2025 10:09:35 AM

Unfounded


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
06/19/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250619083240
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:
07/01/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Karcia Walker, AdministratorTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff allowed residents to leave the facility unsupervised
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Karcia Walker to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
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-20250619083240
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: 07/01/2025
NARRATIVE
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Interviews with Administrators indicated that Resident R1 has exit seeking behaviors which the facility was aware of at time of move in. Interviews indicated that staff continue to monitor R1 at all times and if exit seeking behaviors occur, one staff member will follow R1 to ensure safety while the other staff members stayed at the facility with other residents in care. The facility has protocols in place to ensure resident safety and document all incidents of elopement. All parties were notified during and after each elopement behavior. Documents reviewed indicated that facility was aware of R1’s elopement behaviors and had put procedures in place to redirect and calm R1 when the behaviors occurred. Interviews and documents indicated that R1 never left the facility unsupervised. Records reviewed and interviews conducted indicated that during the incident that occurred on 06/12/2025, R1 opened the front door and walked out of the facility during a behavioral episode. Staff were monitoring R1 during that time and one staff member followed R1 to ensure safety while additional staff stayed at the facility to oversee other residents and call administrators. R1 walked around the neighborhood with staff member. Staff attempted to redirect R1 but were not able to so they continued to follow R1. Eventually returned to the facility once an Administrator had arrived at the facility and was able to redirect R1.

Based on records reviewed and interviews, LPA finds the above allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
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