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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009958
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:14:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230213153057
FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
493009958
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
850
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 894-6037
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:30CENSUS: 17DATE:
05/10/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Center Director, Melissa TerhuneTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff caused injury to daycare child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Strother conducted an unannounced compliant investigation inspection, for the purpose of delivering compliant findings, and met with Center Director, Melissa Terhune. It has been alleged that facility staff caused injury to daycare child, specifically that S1 caused bruising to C1’s right forearm.

During the initial complaint investigation to the facility on 02/22/23 LPA Strother conducted an interview with the Licensee at 10:12am. The Licensee denied the allegation. Licensee stated that she is unaware of staff causing an injury to any child. Interviews were conducted with Staff 2 – Staff 5 (S2-S5) on 02/22/23 with Adult 1 (A1) on 02/21/23. On 02/22/23 LPA requested facility video footage from L1. L1 provided facility video footage dated 02/07/23 on the following dates, 02/22/23, 03/03/23 and 04/11/23. Staff S2-S5 interviewed, all stated that they are unaware of any injury to a child caused by S1 or any other staff. A1 stated that they observed bruises on C1’s arm and that C1 was seen by a medical doctor.
Continue on LIC9099-C
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: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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 7
Control Number 01-CC-20230213153057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 493009958
VISIT DATE: 05/10/2023
NARRATIVE
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On 02/14/23 C1 was seen at Kaiser Permanente, medical records reviewed show that the medical professional observed bruises on C1’s arm in a “strange location…appear to be 3 small circles, possible fingers.” Review of video footage did not reveal clear evidence of an injury to C1 or any other child in care.

Although C1 may have sustained injuries in the form of bruising while in care and interview and record review corroborate that C1 did have bruises on their arm, based on information gathered, there is not a preponderance of evidence to support the injuries occurred due to a staff causing the injury to C1. Based on interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that an alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

This report was reviewed and discussed with facility representative, Center Director, Melissa Terhune. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230213153057

FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
493009958
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
850
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 894-6037
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:33CENSUS: 17DATE:
05/10/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Center Director, Melissa TerhuneTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff yells at daycare child.

Facility staff handled daycare child in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Strother conducted an unannounced compliant investigation inspection, for the purpose of delivering compliant findings, and met with Center Director, Melissa Terhune (D1). It has been alleged that facility staff yells at daycare child, specifically that S1 has yelled at C1 on more than one occasion, including when they get up at nap time. It has also been alleged that facility staff handled daycare child in a rough manner, specifically that S1 grabbed C1’s arm and “yanked” them.

During the initial complaint investigation to the facility on 02/22/23 LPA Strother conducted an interview with the Licensee at 10:12am. The Licensee (L1) corroborated the allegations stating that she has reviewed video footage and did observe S1 yell at C1 on the video and that although she did not observe S1 roughly handle C1 in the video footage, she did observe S1 grab the wrist of another child, C2, stating it was hard to see exactly what happened other than S1 sits C2 down. Interviews were conducted with Staff 2 – Staff 5 (S2-S5) on 02/22/23 and with Adult 1 (A1) on 02/21/23. On 02/22/23 LPA requested facility video footage from L1. L1 provided facility video footage dated 02/07/23 on the following dates, 02/22/23, 03/03/23 and 04/11/23.
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: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 01-CC-20230213153057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 493009958
VISIT DATE: 05/10/2023
NARRATIVE
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During interview S2 stated that on 02/13/23 or 02/14/23 S1 was heard saying to child C2, “You’ve been irritating my soul this week because you’re not listening.” S2 stated that although they could not provide specific dates, they have observed S1 grabbing the wrist of children when they run away or to pull them up from the floor on more than one occasion. S3 stated that on more than one occasion they have heard S1 yelling at the children, things like, “Clean that up.”, “Sit down.” or “Don’t do that.”, yelling from across the room in a voice that sounded angry. S3 stated that they have observed S1 pull up children from the floor by the wrist when they are not listening. During interview, S4 stated that they have heard S1 yelling on more than one occasion, sounding frustrated, yelling “Lay down.” and often directed to child C1. S4 stated that they have not witnesses a child being handled roughly by staff. S5 stated during interview that they could hear S1 yell at children from the neighboring classroom stating the child’s name, and then, “be quiet” or “sit down”. S5 stated that they have witnessed S1 put their arms around C3 trying to get them to calm down and preventing them from getting away, which they feel was rough handling.

A review of video footage shows S1 speaking to children on 02/07/23 at 12:04pm in a manner that is not respectful, specifically when a child (name unknown) says “Can I have some more apple sauce please?” as S1 is putting ketchup on another child’s plate. S1 replies, “No, no you cannot. (S1 shakes her head side to side) Until you learn to raise your hand you cannot have anything." In the footage prior to the child asking for more applesauce it was observed that the child did have their hand up while S1 was communicating to another child, then held their raised hand with their other hand above their head, then puts their hand down, then asks the question, “Can I have some more apple sauce please?” to get S1’s attention. In another video segment on 02/07/23 at 9:54am S1 stands above a child, shouting, “Why did you kick him?”, three times in a row. On 02/07/23 at 10:13am S1 is heard stating “Oh God, why are you crying now?” On 02/07/23 at 9:02am S1 calls “Child’s name, (C2) come here”, then continues talking to the circle of children. Next S1 is heard phonetically stating child’s (C4) name in a stern tone and appears to be looking across the room. S1 then says, “C2 come here.”, again. C2 moves their body close to S1. S1 grabs onto C2’s left hand or wrist (it isn’t clear) and pulls them down to sit. C2 can no longer be seen on the footage.

Based on interviews conducted and records reviewed there is a preponderance of evidence to show that on more than one occasion S1 yelled or spoke in a disrespectful manner at C1 or other children in care and handled C1 or other children in care in a rough manner, therefore the allegations are substantiated.
Continue on LIC9099-C (2)
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 01-CC-20230213153057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 493009958
VISIT DATE: 05/10/2023
NARRATIVE
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The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
Exit interview conducted, and report was reviewed with facility representative, Center Director, Melissa Terhune.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Strother informed facility representative, Center Director, Melissa Terhune that this report dated 05/10/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Strother informed Center Director, Melissa Terhune to provide a copy of this licensing report dated 05/10/23 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A previous licensing report was issued on 08/15/2022 giving notice of the same violation, and as such a $250 civil penalty was assessed for a repeat violation within a 12 month period. See LIC421FC.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 01-CC-20230213153057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 493009958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
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 was not met as evidenced by:
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D1 stated that S1's employment was terminated on 02/14/23. D1 stated she will complete a training and train staff on the following: Self-Care using the following materials provided in an email from LPA Strother:
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Based on interviews conducted and records reviewed S1 has yelled at day care child(ren) in care on more than one occasion, which poses a potential personal rights risk to the children in care.
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View Video: “Self Care: What It Really Is”, Review & Do: Early Childhood Mental Health Consultation – Taking Care of Ourselves, and Review & Practice: “Tell Me What to Do Instead!” Communication is Key Handout (copy provided)
Once training has been completed by 05/31/23, submit a signed and dated statement including the names of the staff that have been trained on Self-Care and Communication concepts. amy.strother@dss.ca.gov.
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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: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 01-CC-20230213153057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
FACILITY NUMBER: 493009958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/11/2023
Section Cited
HSC
101223(a)(3)
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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement was not met as evidenced by:
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D1 stated that S1's employment was terminated on 02/14/23. D1 stated that she and all staff will watch the Children's Personal Rights in Care video on the ccld.ca.gov website and will submit a written procedure for holding staff “strategy meetings” if D1 or other staff report that a staff engages in behavior that is concerning, for the purpose of developing a plan for staff training and follow.
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Based on interviews conducted S1 has handled day care child in care in a rough manner on more than one occasion, which poses an immediate health, safety and personal rights risk to the children in care.
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Written procedures to be submitted by 05/11/23. amy.strother@dss.ca.gov
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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: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7