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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 170107747
Report Date: 05/13/2026
Date Signed: 05/13/2026 12:51:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2026 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20260424101234
FACILITY NAME:CLOVER VALLEY GUEST HOMEFACILITY NUMBER:
170107747
ADMINISTRATOR:WING, ARLENEFACILITY TYPE:
740
ADDRESS:820 CLOVER VALLEY ROADTELEPHONE:
(707) 275-2405
CITY:UPPER LAKESTATE: CAZIP CODE:
95485
CAPACITY:6CENSUS: 5DATE:
05/13/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Arlene Wing, LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal Rights
Facility is not kept clean, safe, and sanitary
Illegal drugs present in facility
Uncleared adults residing or working in the facility
INVESTIGATION FINDINGS:
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On 05/13/2026, Licensing Program Analyst (LPA) Julie Florio, Licensing Program Manager (LPM) Bethany Moellers, LPM, Kimberly Mota, and Regional Manager (RM), Carla Nuti-Martinez arrived unannounced to deliver complaint # 21-AS-20260424101234 investigation findings and met with Arlene Wing, Licensee. The complainant alleges the following: personal rights violations; the facility is not kept clean, safe, and sanitary; there are illegal drugs present in facility; and there are uncleared adults residing or working in the facility.

The Department conducted 10-day complaint investigation visit on 04/24/2026 and obtained documents, made observations, and conducted interviews with Individual 1 (I1), staff and clients which revealed sufficient evidence to support the allegation that the clients’ personal rights have been violated.

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 21-AS-20260424101234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVER VALLEY GUEST HOME
FACILITY NUMBER: 170107747
VISIT DATE: 05/13/2026
NARRATIVE
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Continued from LIC9099...

I1 expressed frustration that the clients were allowed to “go wherever” they wanted in the common areas. I1 explained that clients should be in their rooms between 2100 hours to 0800 hours and I1 expressed being upset that the clients have access to the whole house. Staff and client interviews revealed that I1 “gets loud” with them, has had verbal altercations with them, screams and yells at them, acts erratic, makes them feel uncomfortable, and has reviewed unsecured client files without their consent. Both staff and client interviews revealed that there have been multiple instances where a pin was observed inserted in the sliding door that provides the female clients with access to the living room. The pin in the door prevented the door from opening. Interviews also revealed that I1 stated they had drilled the hole and placed the pin into the door to lock it. During facility inspection, the Department observed a hole in the door consistent with interviews conducted. Interviews with staff and clients revealed that I1 locked the refrigerator preventing the clients access to food on more than one occasion.

Interviews with I1 and staff, along with a review of available information, revealed sufficient evidence to support the allegation that the facility is not kept clean, safe, and sanitary. It was revealed that I1 may possess or store firearms at the facility. I1 admitted possessing firearms but denied storing them at the facility; however, one staff witness observed I1 with a firearm on the premises in 2025. Staff also reported that I1 made verbal threats involving the use of a firearm against clients or other individuals in 2025 and 2026. I1 and Licensee denied access to I1’s room, preventing verification of whether firearms were present or stored inside. Additionally, I1 resides in a room where the entryway was observed obstructed. Licensee stated they did not have key or access to this room in the event of an emergency. As mentioned above, I1 locked clients in area of the facility which is not approved to be locked. During the 04/27/2026 facility visit, LPA and LPM smelled a urine odor in the facility, and observed unsecured medications, motor vehicle chemicals, pesticides, and manual and power tools accessible to clients in care. Interviews with staff and clients revealed that they have observed containers of human urine and feces around the facility.

Interviews with I1, staff and clients revealed sufficient evidence to support the allegation that I1 may possess, store, or consume controlled substances at the facility. In April 2026, Client 1 (C1) directly observed I1 smoking a glass pipe used with methamphetamines on the premises and reported that I1 made comments regarding seeking money to buy and share drugs. I1 and Licensee denied access to I1’s room, preventing verification of whether controlled substances were present or stored inside.

Continued on LIC9099C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20260424101234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVER VALLEY GUEST HOME
FACILITY NUMBER: 170107747
VISIT DATE: 05/13/2026
NARRATIVE
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Continued from LIC9099C...

The Department issued a citation on 05/01/2025 for uncleared individuals being present at the facility. At that time, the Licensee stated they planned to make I1 a client of record. During the 04/27/2026 complaint investigation visit, the Licensee did not have the required documentation per regulation to verify that I1 was a client. I1 resides in a room that is not fire cleared for clients. Per interview with Licensee, it was revealed that I1 is more of a tenant than a client and that they have a verbal agreement allowing I1 to live there. I1 is not fingerprint cleared as required per regulation for all non-clients residing in the facility.

Based on interviews conducted, observations made, and records reviewed, the allegations listed above are SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited from Title 22 Regulations, Division 6.

Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20260424101234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CLOVER VALLEY GUEST HOME
FACILITY NUMBER: 170107747
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2026
Section Cited
CCR
87202(a)
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Fire Clearance 87202(a): (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.[...] This requirement is not met as evidenced by:
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Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.
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Based on observations made, photos obtained, and interviews conducted, the Department confirmed that clients were restricted to one area in the facility, which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
05/14/2026
Section Cited
CCR
87303(a)
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Maintenance and Operation 87303(a) : The facility shall be clean, safe, sanitary and in good repair at all times.
This requirement is not met as evidenced by:
Based on interviews conducted, the Department confirmed that I1 made verbal threats involving the use of a
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Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.
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firearm against clients and other individuals, LPA observed unsecured chemicals, tools, medications, and smelled a urine odor, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20260424101234
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CLOVER VALLEY GUEST HOME
FACILITY NUMBER: 170107747
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is not met as evidenced by:
Based on interviews conducted, the Department confirmed that I1 was observed
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Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.
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using a glass pipe used in methamphetamines at the facility, which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
05/14/2026
Section Cited
HSC
87355(e)
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87355 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:
This requirement is not met as evidenced by:
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Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.
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Based on observations made, records obtained, and interviews conducted, the Department confirmed that I1 is an uncleared adult on the facility grounds, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
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