<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005744
Report Date: 11/19/2021
Date Signed: 11/19/2021 04:03:07 PM

Document Has Been Signed on 11/19/2021 04:03 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:SILVER LINING CARE HOMEFACILITY NUMBER:
347005744
ADMINISTRATOR:EVELINA AND PAVEL MAGUREANFACILITY TYPE:
740
ADDRESS:8189 PLUMERIA AVENUETELEPHONE:
(916) 241-9186
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 4DATE:
11/19/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Evelina Magurean, Administrator TIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Elena Romarniuc, caregiver, who contacted Administrator, Evelina Magurean, who, arrived shortly to the facility. LPA explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Facility currently has (4) residents and (3) residents are on hospice. (1) resident is currently out of the facility at a skilled nursing but is expected to return in the upcoming weeks. LPA observed (1) resident to be in the front room watching television and (3) to be in their rooms.

LPA and Administrator toured the interior of the facility. LPA observed it to be clean, in good repair and to be odor free. Rooms toured include (6) private bedrooms, kitchen, laundry, and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 72 F. Fire extinguishers last serviced 7/18/2021 and smoke/monoxide alarms are in working order, LPA observed sufficient 2+day perishable and 7+day non-perishable food and PPE supply. LPA observed paper towels, soap and sanitizer in the bathrooms and hand-washing Covid posters by all sinks. Sharps, toxins and medications are secured appropriately. LPA and Administrator discussed vaccination status of residents and staff, testing requirements, and reviewed PIN 21-40 issued 8/27/2021 regarding visitation protocols. All staff are cleared and were requested to be associated to the facility. A completed Mitigation Plan was emailed to the Department on 2/27/2021- LPA to follow up if an approved copy was provided to facility. LPA and Administrator discussed delays in Administrator recertification. Administrator agreed to follow up with the Department and provide any required documentation by Friday, 11/26/2021. The report was discussed with Administrator while LPA was at the facility.

There are no deficiencies cited in today's report. Due to technical difficulties, the report was e-mailed to the Administrator following today's inspection, at approximately 4:00 pm, to obtain a signature.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1