Senior Care Records.

Facility Evaluation Report

Clover Valley Guest Home, Upper Lake08/06/2025Licence 170107747

Capacity6
Census4
Date signed08/06/2025 04:37:46 PM
Name of licensing program analystJulie Florio
Name of licensing program managerBethany Moellers
The inspector’s account

At approximately 1:45 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Licensee, Arlene Wing, was contacted via telephone and arrived at approximately 2:45 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with 4 residents in care. Facility is approved for 6 non-ambulatory residents and has a Hospice waiver for 2.

At approximately 1:45 AM, LPA initiated a tour of the facility with staff and observed the following: Facility is a one story building, was a comfortable temperature, and passageways were free from obstructions. Facility has agreed to post warning signs at all faucets and showers that test above the allowable water temperature range of 105 to 120 degrees F per Title 22 regulations in order to bring the facility into compliance. LPA observed a supply of hygiene products, clean linens, paper products, and incontinent care briefs available for residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were observed centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. Facility has internet available to residents in care and the phone was tested an operational. Facility agrees to purchase an internet access device and have it available to residents in care.

Facility's fire extinguishers were observed charged and were last serviced 05/2025. Facility Smoke and Carbon Monoxide detectors were tested and operational during inspection.

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