CLOVER SENIOR CARE

1171 CLOVER DRIVE, Santa Rosa CA 95401

Facility 496803672 · RESIDENTIAL CARE ELDERLY (740)

6 bedsLatest official report Aug 26, 2025Licensed

Additional info
Licensee
CLOVERUS INC
Administrator
KUMAR, AMI
Contact
KUMAR, AMI
License first date
Oct 11, 2017
License effective date
Oct 11, 2017
District office
SANTA ROSA RO · (707) 588-5026
Regional office
21
Clients served
983 - RCFE / DEMENTIA

Summary

The available records show 3 Type A and 4 Type B deficiencies for this facility.

Most recent inspection
Aug 26, 2025
Most recent deficiency
Aug 26, 2025

No later report is available, so the records do not show what happened afterward.

What Type A and Type B mean
Type A
Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
Type B
Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.

Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.

At a glance

Counts cover the five-year public record. Typical figures are the median for the 111 Sonoma County facilities licensed for 6 or fewer beds.

In the available public five-year record, CCLD published 7 reports for this facility: 7 inspections, 0 complaint investigations, and 0 licensing or administrative records.

Those records contain 3 Type A and 4 Type B deficiencies.

0 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections
7

More than the typical 5

0 in the last 12 months

Recorded deficiencies
7

More than the typical 4

0 in the last 12 months

Type A deficiencies
3

More than the typical 1

0 in the last 12 months

Type B deficiencies
4

More than the typical 2

0 in the last 12 months

Substantiated complaints
0

Most this size also have none

0 in the last 12 months

Repeated topics
0

Last 36 months

No inspection in the last 12 months, so a zero above means no record rather than a clean visit.

Repeated topics

Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Inspection
Medication handling and storageType A
Official classification
Type A
Official code
87465(h)(5)
Regulation authority
CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin observation and interview, the licensee did not comply with the section cited above in that facility is pre-pouring medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2025 Plan of Correction Facility to submit LIC9098 self-certifying they will immediately cease pre-pouring medications, by plan of correction due date.

Plan of correction recorded
Correction not verified in available records
View official report
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
87411(f)
Regulation authority
CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin record review, the licensee did not comply with the section cited above in that S1, S2, S3, and S5 did not have TB clearance and S4 and S5 did not have Health Screens on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2025 Plan of Correction Facility to submit TB clearance for S1, S2, S3, and S5 and Health Screens for S4, and S5 by plan of correction due date.

Plan of correction recorded
Correction not verified in available records
View official report
Admission, assessment, and evictionType B
Official classification
Type B
Official code
87458(c)(1)(A)
Regulation authority
CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin record review, the licensee did not comply with the section cited above in that R2 did not have TB clearance on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2025 Plan of Correction Facility to submit to CCL proof of TB clearance for R2 by plan of correction due date.

Plan of correction recorded
Correction not verified in available records
View official report
Admission, assessment, and evictionType B
Official classification
Type B
Official code
87463(a)
Regulation authority
CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA and Admin record review, the licensee did not comply with the section cited above in that R1 and R3 did not have a current appraisal/pre-appraisal on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2025 Plan of Correction Facility to submit to CCL completed appraisals for R1 and R3 by plan of correction due date. Appraisals to be signed by resident/resident's responsible party. If responsible party cannot sign, proof of delviery to repsonsible party must also be submitted.

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Fire safety and emergency preparednessType B
Official classification
Type B
Official code
87202(a)
Regulation authority
CCR

What the official deficiency says

(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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate 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: Deficient Practice Statement Based on LPA's/Licensee observation, the Licensee did not comply with the section cited above in 2 out of 2 fire extinguisher was not serviced since April 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2024 Plan of Correction Licensee will contact the Fire Department to have fire extinguisher serviced. Licensee agreed to submit self-certification form as a proof of Correction (POC) that fire extinguishers have been serviced and charged by a fire extinguisher service company or the Fire Department by POC due date 10/31/2024.

Plan of correction recorded
Correction not verified in available records
View official report
Inspection
Background checksType A
Official classification
Type A
Official code
87355(e)
Regulation authority
CCR

What the official deficiency says

(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: Deficient Practice Statement Based on LPA observation, record review and interview with Licensee did not ensure to obtain a criminal record clearance for staff (S1) prior to work, reside or provide care to residents in care which poses an immediate health, safety and personal rights risk to residents in care. ***Civil Penalty is being assesed for the amount of $500.

Official plan of correction

POC Due Date: 08/09/2023 Plan of Correction Licensee removed staff (S1) from the premises and from the work schedule until S1 has a clearance as required by law. Licensee will submit a self-certification LIC9098 ensuring that regulation was understood to CCL by POC due date.

Plan of correction recorded
Correction not verified in available records
View official report
Medical and dental careType A
Official classification
Type A
Official code
87465(a)(6)
Regulation authority
CCR

What the official deficiency says

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not maintaining a Centrally Stored Medication Log which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/09/2023 Plan of Correction Facility to review and update the Centrally Stored Medication Log by POC due date. Licensee will submit self-certification LIC9098 notifying CCL that CSMR its current. LPA will return to review.

Plan of correction recorded
Correction not verified in available records
View official report

Source and limits

California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.

Read the data methodology