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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009957
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:05:15 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) 894-6037
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:9CENSUS: 8DATE:
09/28/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
03:30 PM
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On 09/28/21 at 11:50am LPA Strother made an unannounced Plan of Correction (POC) visit to the facility. The purpose of today's visit was to clear two citations the facility received during prior visits. On 08/03/21 the facility was cited based on staff interviews conducted during a complaint investigation corroborating that the staff with the school age children did 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. During a Plan of Correction inspection on 08/18/21 the school age children had been combined with the preschool age children and did not have a qualified teacher on cite to separate them from the preschool children during the inspection. LPA was unable to clear the citation from 08/03/21 during the visit. During today's visit the school age children arrived to the facility with a fully qualified teacher and aide and then were under the care and supervision of Licensee, Jeanette Boehm (L1), a fully qualified teacher. LPA's observations clear the deficiency.

On 08/04/21 the facility received a citation based on LPA observations and interviews conducted which corroborated that school-age children have joined the preschool and toddler children for lunch in the preschool room and played with the preschool children on the playground on more than one occasion. On 08/18/21 the facility received a citation based on LPA's observation that the school age children were combined in care with preschool children on the School age playground. During today's inspection the school age children were not present at the facility when LPA Strother arrived. During an interview with Licensee Jeanette Boehm (L1), L1 stated that at 2:00pm two staff, a fully qualified teacher and an aide walk to the local elementary school to meet the school age children that are enrolled at the facility and walk the school age children back to the facility. LPA observed the teacher and aide return with the school age children, L1 took the school age children to the school age classroom, keeping them physically separate from the toddler and preschool age children and in compliance with regulation requirements, clearing the deficiency.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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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