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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700958
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:14:27 PM

Document Has Been Signed on 06/12/2024 01:14 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SILVANA SENIOR CARE 2FACILITY NUMBER:
312700958
ADMINISTRATOR/
DIRECTOR:
MITITI, BIANCAFACILITY TYPE:
740
ADDRESS:1245 CRESCENDO DRTELEPHONE:
(916) 586-4713
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
06/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 6/12/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator arrived to assist.

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. The home is clean. One of five residents are able to participate in an interview- resident stated they are happy with care. All residents observed to have their care needs met during this inspection.

LPA reviewed 5 resident files. Files are complete and well organized. Recent incident of a fall with injury of R2 was discussed. Needed care was provided and R2 has returned to baseline.

LPA reviewed 2 staff files. Files are complete. S1 interviewed and expressed understanding of current resident care needs.

LPA and licensee discussed needed documents from Home Health and hospice and notification vs approval of family members for identified medical evaluation of residents.

LPA requested copies of the following be submitted to CCL: Liability insurance certificate, LIC 500, resident roster and personnel docs for S2, by 6/19/24.

No deficiencies are being cited as a result of todays inspection.
Exit interview conducted with licensee and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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