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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002859
Report Date: 10/19/2022
Date Signed: 10/19/2022 05:32:01 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
07/28/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20220728091717
FACILITY NAME:SILVANA SENIOR CARE 5FACILITY NUMBER:
315002859
ADMINISTRATOR:SANDOR IVASCU, MIRELFACILITY TYPE:
740
ADDRESS:2505 CORIN DR.TELEPHONE:
(916) 966-8562
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 6DATE:
10/19/2022
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Mirel Ivascu TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility not following their refund policy
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Talwinder Bains and Licensing Program manager (LPM) Laura Munoz arrived at the facility unannounced on 10/19/22 to do the complaint investigation for above allegation. LPA and LPM met with administrator Mirel Ivascu and explained the purpose of the visit. Prior to the visit , LPA and LPM completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA and LPM wore the following Personal Protective Equipment (PPE) during today's visit-surgical masks. LPA and LPM were screened by facility staff upon entry.

The department conducted records review ,observations and interviews.


**Report continued on LIC9099-C**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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 3
Control Number 25-AS-20220728091717
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 5
FACILITY NUMBER: 315002859
VISIT DATE: 10/19/2022
NARRATIVE
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Continue from 9099-----------

Licensee acknowledged on 08/02/22 not paying refund to the family/responsible party of R1 who was deceased on 06/28/22. R1's board and care rate was paid untill 07/10/22. Based on regulation requirements (87507(g)(5)(A)(1) Admission Agreements), facility should have paid refund to R1's responsible party from 06/29/22 through 07/10/22 within 15 days for R1's death. During today's visit, licensee stated payment was issued to R1's responsible party on or around August 3, 2022.

Based on Title 22 regulations, licensee did not issue a refund to R1's responsible party within 15 days therefore, LPA finds that the allegation cited above is Substantiated.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.



Exit interview with administrator. Appeals rights provided. Copy of the report provided to facility.






SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220728091717
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 5
FACILITY NUMBER: 315002859
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2022
Section Cited
CCR
87507(g)(5)(A)(1)
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87507(g)(5)(A)(1)- Admission Agreements(g) Admission agreements shall specify the following:
(5) Refund conditions(A) Facility policy concerning refunds, ...conditions under which a refund for ... fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652… must be made to the individual...for the payment of the resident’s fees,... identified in admission agreement. 1569.652(c) A refund …
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Licensee will submit a statement of understanding of this regulation and proof of payment of refund to CCL by the POC date- 11/03/22.
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within 15 days after the personal property is removed. This requirement was not as evidence by- facility did not pay the refund to R1s family/responsible party within 15 days of R1s death as required per regulation.
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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: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3