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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700982
Report Date: 10/02/2023
Date Signed: 10/02/2023 10:04:40 AM


Document Has Been Signed on 10/02/2023 10:04 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:
10/02/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee, Krisztina IvascuTIME COMPLETED:
10:20 AM
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 On 10/02/23, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility and met with Licensee, Krisztina Ivascu. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA explained the reason of today's visit is regarding immediate exclusion order for staff ,S1 which was delivered by department on 11/10/22 to facility . According to "Immediate Exclusion" notice indicated that staff member (S1) cannot be allowed to work, be present and/or live in a CCLD licensed facility or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Licensee indicated they understood the notice and confirmed that S1 is currently not working at the facility and has no contact with facility in any nature after the "Immediate Exclusion " notice was delivered.

LPA inspected the facility during today's visit. LPA did not observe any Health and Safety concerns for the residents in care at this time.

Exit interview completed. No deficiencies are being cited. Copy of report was provided to the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2023
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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