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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002859
Report Date: 03/17/2022
Date Signed: 03/17/2022 11:10:03 AM

Document Has Been Signed on 03/17/2022 11:10 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SILVANA SENIOR CARE 5FACILITY NUMBER:
315002859
ADMINISTRATOR:SANDOR IVASCU, MIRELFACILITY TYPE:
740
ADDRESS:2505 CORIN DR.TELEPHONE:
(916) 966-8562
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 0DATE:
03/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Krisztina and Mirel IvascuTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 03/17/2022, to conduct a prelicensing visit. This is a brand new facility. LPA met with Facility Applicants Krisztina and Mirel Ivascu, and explained the purpose of the visit. Prior to initiating 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 they washed hands just after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Applicant.

This facility has a fire clearance for six non-ambulatory residents. There is a gate enclosing the front area of the facility and the gate is not locked and shall not be locked. This facility has five resident rooms; one shared and four private. The shared resident room has a full private bathroom. There is a half common bathroom and a full common bathroom. The front door opens to the main sitting, dining, and kitchen areas. To the left of the facility there is a hallway that leads to shared resident room that has a full private bathroom and exit to the outside, a private resident room, and a laundry room that leads to the garage. To the right of the main entrance there is a hallway that has three private resident rooms, a half common bathroom, and a full common bathroom. There are locked cabinets for medications and confidential files in the kitchen/dining area. There is a pantry next to the kitchen. In the backyard there are two partial covered patio covers. There is a fountain in the backyard that applicants are deciding if they want to use it or not. Suggestions were made to make it inaccessible to residents if it is going to be used. There is a gate on the same side as the garage.

Several topics were discussed during this visit.

Component III orientation was waived.

This facility meets licensing requirements. LPA is going to submit this to applications specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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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