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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700982
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:28:19 PM


Document Has Been Signed on 08/02/2022 03:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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:
08/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Doris Barnes, CaregiverTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Jacob Williams arrived at the facility unannounced on 08/02/2022, to conduct a case management visit. LPAs conducted COVID-19 Precautionary prescreening and wore surgical masks while at facility. LPA was screened by caregiver.

The purpose of today's visit is in response to a self-reported incident from Licensee Krisztina Ivascu that occured on 7/22/2022 around 12:39pm. The incident revolved around a clients family making an accusation at the facility of an incident occurring between a client and staff. LPA spoke with Licensee and Ombudsman prior to visiting facility. While at the facility, LPA spoke with staff, spoke with resident, reviewed SOC341, incident report, hospital visit summaries, reviewed written staff statements, reviewed photo evidence and requested police report and client's family's phone numbers.

Based on today's inspection, no deficiencies were identified.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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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