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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700958
Report Date: 09/03/2021
Date Signed: 09/03/2021 02:33:18 PM

Document Has Been Signed on 09/03/2021 02:33 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 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
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Krisztina IvascuTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/3/21 to conduct a Annual Inspection utilizing the infection control domain. LPA met with Licensee and explained the purpose of the visit. Prior to initiating the inspection, 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 and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by caregiver upon entering the facility.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Licensee completed the infection control domain and facility was found to be in substantial compliance at this time.

LPA advised: more visible hand washing signs at all hand washing sinks, record staff vaccination status and weekly testing of those not fully vaccinated, and procurement of proper N-95s for staff to be fit tested.
LPA provided handouts and links for additional resources. LPA also provided PIN 21-02 for guardian registration and staff roster management.
Additionally LPA reviewed securing cleaning supplies and over the counter medications, facility's fire door hinge is not working properly and is to be repaired and staff are not to use a resident sitting room as a break area.

LPA requested Administrator submit: Resident roster, staff roster, Administrator Certificate and Liability insurance to CCL by 9/3/21.

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

LIC809 (FAS) - (06/04)
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