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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700958
Report Date: 09/03/2021
Date Signed: 09/03/2021 02:29:03 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
08/31/2021 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20210831084218
FACILITY NAME:SILVANA SENIOR CARE 2FACILITY NUMBER:
312700958
ADMINISTRATOR:IVASCU, MIRELFACILITY TYPE:
740
ADDRESS:1245 CRESCENDO DRTELEPHONE:
(916) 586-4713
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
09/03/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Krisztina IvascuTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility failed to issue a refund.
INVESTIGATION FINDINGS:
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 On 9/3/21, Licensing Program Analyst (LPA) Kevin Mknelly conducted a complaint investigation visit for the above allegation. LPA met with Licensee Krisztina Ivascu
LPA interviewed the licensee.
LPA finds that the allegations cited above are substantiated.
Licensee acknowldged that R1 passed away on 7/24/21 and personal belongings out of the facility the next morning on 7/25/21. Licensee stated that R1's representatives have not yet been provided a refund.
Licensee will submit a copy of R1s admission agreement.
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 following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.
Report reviewed and copy prvided to the licensee. Additionally, LPA provided appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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 2
Control Number 25-AS-20210831084218
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 2
FACILITY NUMBER: 312700958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
HSC
1569.652
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Admission agreements- Refunds
(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s
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Licensee will provide proof of reimbursement to R1's representative for an agreed upon amount to CCL by the POC date of 9/17/21.
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estate, within 15 days after the personal property is removed. This requirement was not met.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
LIC9099 (FAS) - (06/04)
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