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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700982
Report Date: 10/26/2023
Date Signed: 10/26/2023 11:00:52 AM


Document Has Been Signed on 10/26/2023 11:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 3FACILITY NUMBER:
342700982
ADMINISTRATOR:MITITI, BIANCAFACILITY TYPE:
740
ADDRESS:7662 COPPER COVE PL.TELEPHONE:
(916) 586-4713
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 6DATE:
10/26/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:caregiverTIME COMPLETED:
11:00 AM
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On 10/26/23, Licensing Program Analyst (LPA), Kevin Mknelly arrived at the facility unannounced. LPA notifies caregiver of the reason for the visit.Caregiver nofitied Kryistina Ivascu who arrived to assist wit the visit.

LPA conducted the visit and interviewed R1 related to an issue unrelated to this facility.
LPA reviewed records regarding R1.

No deficiencies are noted as a result of this visit.

Report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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