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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009957
Report Date: 10/12/2020
Date Signed: 10/21/2020 04:17:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER-S/AFACILITY NUMBER:
493009957
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
840
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 318-3951
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:7CENSUS: 0DATE:
10/12/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jeanette Boehm and VijayKumar PatelTIME COMPLETED:
03:00 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
The facility inspection was conducted via tele-inspection due to the Covid-19 state of emergency pandemic. The department has suspended all field operations and the applicant has agreed to conduct the video conference with LPA, (Licensing Program Analyst) Glenn Ouye and Yang Yang.

The purpose of the visit was to conduct a prelicensing visit. The applicant for a combination center submitted the application on July 9, 2020. The program will provide infant care, a toddler component, preschool and a school age program.

The applicant and the director toured the LPA's through the interior and exterior of the facility. The school age application is requesting a capacity of 9 school age children. The square footage of the facility supports the capacity for the program. A single detached room is to be used for the school age program. There are two toilets and two hand washing stations for the school age children. The applicant is aware of the child:teacher ratio for the school age program. There are ample age appropriate toys and equipment available for the children. There is a functional smoke and carbon monoxide detector and a fully charged 2A10BC fire extinguisher. The cleaning supplies and chemicals are stored in the laundry room. The laundry room to wash clothing and linens is located in a locked closet on the rear porch. The outdoor play area for the school age children is fully fenced and separated from the other program age groups. Wood chip are sufficient to provide fall protection. There is a adequate shade from the trees in the outdoor play area. The facility has an adult staff is in the main building. The facility has a functioning heating/air conditioner which was tested during the site visit.

The facility is granted licensure effective 10/20/2020.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2020
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