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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009957
Report Date: 08/03/2021
Date Signed: 08/03/2021 06:34:40 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2021 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210412105943
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:9CENSUS: 2DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:TIME COMPLETED:
06:33 PM
ALLEGATION(S):
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Unqualified staff teaching children at facility
Licensee does not treat a daycare child with dignity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Strother made a subsequent complaint investigation inspection for the purpose of delivering the findings, and met with Licensee, Jeanette Boehm (L1). It has been alleged that Unqualified staff teaching children at facility, specifically that an aide is left with the school age children when L1 has been absent on more than one occasion, and Licensee does not treat a daycare child with dignity, specifically that L1 has screamed at Child 7 (C7) in the presence of staff and children.

During the initial complaint investigation Tele-visit to the facility on 04/21/21, LPA met with L1 using Zoom at 12:18pm. During an interview with L1 on 04/21/21, L1 denied the allegations, stating that she doesn't have unqualified staff working in the school age classroom and she doesn’t believe that statement that she didn't treat someone with dignity.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 6
Control Number 01-CC-20210412105943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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/A
FACILITY NUMBER: 493009957
VISIT DATE: 08/03/2021
NARRATIVE
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Five staff (S1-S3 and S5-S6) were interviewed on 04/20/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21 and 05/26/21.
Staff interviews corroborate that one more than one occasion S6 was left alone with a group of up to 7 school-age children. Record review and a statement from S6 confirm that S6 does not hold any units in Early Childhood Education, is not a qualified teacher, was hired as an aide and therefore cannot be solely responsible for the care and supervision of the children in care. Staff interviewed stated that on more than one occasion L1 yelled at Child 7 (C7) for messing around on their Zoom class, not paying attention or not doing their school work in front of the other children in care, corroborating the allegation that L1 does not treat a daycare child with dignity.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

The Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 01-CC-20210412105943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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/A
FACILITY NUMBER: 493009957
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/17/2021
Section Cited
CCR
101216.2(e)
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101216.2 Teacher Aide Qualifications and Duties (e)An aide shall work only under the direct supervision of a teacher.
This requirement is not met as evidenced by:
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L1 stated that she has hired two new fully qualified teachers, stating one teacher will start 08/09/21 assigned as a floater covering breaks and subbing as needed in preschool or school-age room. The second will start on 08/17/21 assigned as a second preschool teacher.
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Based on staff interviews Staff 6 (S6) does not hold units in Early Childhood Education, was hired as an aide and was the only staff present with the school age children on more than one occasion. This poses a potential health and safety risk to the children 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.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 01-CC-20210412105943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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/A
FACILITY NUMBER: 493009957
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2021
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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L1 stated that she has already conducted a staff training on personal rights with staff on 04/25/21. L1 will review the personal rights regulations and sign and date that she has read and understands the personal rights regulations. L1 stated that she will hold a staff training to include newly hired staff and current staff on 08/29/21 and submit training notes and materials covered to LPA by 08/30/21.
amy.strother@dss.ca.gov
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Based on staff interviews L1 on more than one occasion L1 yelled at Child 7 (C7) for messing around on their Zoom class, not paying attention or not doing their school work in front of the other children in care. This poses an immediate health and safety risk to the children 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.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2021 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210412105943

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:9CENSUS: 2DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jeanette BoehmTIME COMPLETED:
06:33 PM
ALLEGATION(S):
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Licensee disclosed a daycare child's private information
Licensee has a daycare child clean the facility bathroom

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Strother made a subsequent complaint investigation inspection for the purpose of delivering the findings, and met with Licensee, Jeanette Boehm (L1). It has been alleged that Licensee disclosed a daycare child's private information, specifically that the private information was discussed with staff in front of other children and Licensee has a daycare child clean the facility bathroom, specifically that L1 has had Child 7 (C7) clean the bathroom and take out the trash on more than one occasion.

During the initial complaint investigation Tele-visit to the facility on 04/21/21, LPA met with L1 using Zoom at 12:18pm. During an interview with L1, L1 denied the allegations, stating that she has not disclosed a child's private information, except what needs to be known by staff, such as medical issues, or anything that has to do with the care of the children, and she has never had a child clean the bathroom.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 01-CC-20210412105943
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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/A
FACILITY NUMBER: 493009957
VISIT DATE: 08/03/2021
NARRATIVE
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Five staff (S1-S3 and S5-S6) were interviewed on 04/20/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21 and 05/26/21. Staff interviewed were unable to corroborate the allegations that Licensee disclosed a daycare child's private information and that Licensee has a daycare child clean the facility bathroom. Based on interviews, there is not a preponderance of evidence to prove that L1 disclosed a child’s private information resulting in a violation of a child’s personal rights. Staff interviewed stated that the information L1 shared was regarding children’s health related information that was directly related to the care of the children. Staff interviewed stated that although they have witnessed a daycare child, Child 7 (C7) sweep and take out the trash, C7 did not have access to cleaning disinfectants, cleaning solutions, or other items that could pose a danger if available to children.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted. The Notice of Site Visit must be posted for 30 days. Appeal rights were provided.

There were no Title 22 deficiencies cited related to this report.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6