Senior Care Records.

Facility Evaluation Report

Clover Valley Guest Home, Upper Lake12/21/2021Licence 170107747

Capacity6
Census4
Date signed12/21/2021 01:10:09 PM
The inspector’s account

On 12/21/2021 at approximately 12:30 PM Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a Case Management inspection and met with Administrator, Arlene Wing. LPA was temperature check and singed in on provided log for all visitors.

LPA was following up on a previous complaint regarding infection control/Mitigation Plan and that facility is following through on their plan of correction: All staff will wear required face mask – Vaccine exemptions and documentation of weekly COVID testing are kept in file and that check in log has temperatures included and are documented both in and out each day of work. LPA confirms staff log in and out sheets have been filled in with temperatures and signed Religious exemptions for all staff as well as copies of weekly testing were provided.

LPA dropped off additional postings for facility.

No deficiencies cited during this inspection.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction