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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700982
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:29:49 PM


Document Has Been Signed on 02/07/2023 01:29 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:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Administrator, Bianca Mititi TIME COMPLETED:
01:45 PM
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LPA Bains arrived on 02/07/2023 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA met with administrator , Bianca Mititi and explained the purpose of the visit. LPA was screened by facility staff upon entry.

LPA and administrator completed the infection control domain together.
Facility was found to be in substantial compliance.

LPA and administrator conducted a facility tour. Areas toured included: entryway, kitchen, backyard, living room, five residents bedrooms , two resident bathrooms and staff room . In the areas toured, no health, safety, or personal rights violations were observed.

Licensee to send in updated copy of LIC 308 - Designation of Facility Responsibility,
LIC 500 - Personnel Report to Community Care Licensing by 02/21/2023.


No deficiencies are being cited as a result of todays inspection.
Exit interview conducted. A copy of this report was left at the facility.



SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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