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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009957
Report Date: 09/21/2023
Date Signed: 09/21/2023 12:09:07 PM

Document Has Been Signed on 09/21/2023 12:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER-S/AFACILITY NUMBER:
493009957
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
840
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 894-6037
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 0DATE:
09/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a capacity decrease for the school age program. The is requesting a lower capacity back to nine school age children since the capacity of the preschool program will be utilizing the indoor area formerly used by the school age children.

There is sufficient indoor and outdoor square footage for the nine school age children.

The capacity change from 18 to 9 children is approved effective September 21, 2023.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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