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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009957
Report Date: 04/07/2022
Date Signed: 04/07/2022 11:58:47 AM


Document Has Been Signed on 04/07/2022 11:58 AM - 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:9CENSUS: 0DATE:
04/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPA's) Glenn Ouye and Amy Strother arrived unannounced to conduct a case management visit to determine capacity limits for the school age program. The licensee has submitted an application to increase the capacity of the facility from 9 to 18 school age children on March 28, 2022.

The school age program will utilize 3 rooms to the left side of the center hallway as children enter the facility through the main front door. The total square footage of the interior and outdoor activity areas were measured. The interior space is sufficient for 18 school age children. The outdoor area is large enough to support the school age children. There are two unisex bathrooms for the children.

The approved fire inspection by the Cloverdale Fire Department was received on March 30. 2022.
The prior school age indoor space will no longer be used by the school age program and the room will become a facility storage area.

The capacity increase from 9 to 18 school age children will be approved and effective Monday, April 11, 2022.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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