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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009958
Report Date: 08/03/2021
Date Signed: 08/05/2021 04:33:03 PM

Substantiated


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-20210412095247
FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
493009958
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
850
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 318-3951
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:30CENSUS: 15DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jeanette BoehmTIME COMPLETED:
08:13 PM
ALLEGATION(S):
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Uncleared workers present at facility
Facility is operating out of ratio
Staff are rough with daycare children
Licensee does not provide safe environment
Facility grounds in disrepair
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 uncleared workers present at facility, facility is operating out of ratio, staff are rough with daycare children, Licensee does not provide safe environment and facility grounds are in disrepair.

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 that the allegation that uncleared workers are present at the facility, stating that everyone has a criminal record clearance, denied that the facility is operating out of ratio, stating that she doesn’t believe she has ever been out of ratio, but didn’t understand that aides are required to have units if there are more than 15 children with a qualified teacher in the preschool room. L1 admitted that staff, former Director (D1) was rough with a day care child on 04/16/21, an incident that L1 had reported to the department on 04/16/21, stating that to her knowledge it has not happened any other time.

Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
VISIT DATE: 08/03/2021
NARRATIVE
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L1 admitted that children have found rusty nails and mushrooms were found growing on the playground, but her knowledge all of nails are now gone and the yard is checked daily for mushrooms. L1 denied the allegation that the facility grounds are in disrepair, stating that the hot water heater in the school age room has an issue that causes the sink water to smell, stating that the preschool children use the school age bathroom sink when playing outside.

Six staff (S1-S6) were interviewed on 04/15/21, 04/20/21, 04/21/21, 04/23/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received from L1 on 05/04/21 and 5/18/21. Based on interviews and a review of records, two individuals, Adult 1 (A1) and Staff 6 (S6) were working at the facility, engaging in the care of children without a criminal record associated to the facility. Records reviewed on 07/14/21 show that A1 was associated to the facility on 05/04/21. S6 is not and has never been associated to the facility, and last worked at the facility on 04/02/21.

All staff interviewed corroborated that the preschool has had more than 15 children, and up to 20 children in care on more than one occasion with one qualified teacher and 1 or two aides that do not hold units in Early Childhood Education.

Staff interviewed corroborated that they have observed staff D1 engage roughly with daycare children. Staff have observed D1 being rough with the following children: Child 1 (C1), Child 2 (C2), Child 3 (C3), Child 4 (C4), Child 5 (C5) and Child 17 (C17). Staff stated that the rough handling of the children by D1 occurred inside and outside. D1 would yell at children, saying "I'm talking to you, do you not listen?", then grab them by the arm forcefully and tell them to look at them and then tell them what they needed to do. If the child didn't listen, D1 would grab their arm, pull their arms to direct them were they wanted them to be. Staff stated that they told L1 that D1 was being rough with the children multiple times. Staff reported that red marks were observed on C1, C4 and C5's arms after D1 grabbed them.

Staff corroborated the allegation that the Licensee does not provide a safe environment, stating that on more than one occasion rusty nails or screws were found by children, and although L1 was told about the rusty nails and screws, children were still finding them days later. Staff stated that although mushrooms were present in on the playground, they would pick them and throw them away, but were not instructed to scan the yard for safety prior to the children going outside.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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: 8 of 8
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-20210412095247

FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
493009958
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
850
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 318-3951
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:30CENSUS: 15DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jeanette BoehmTIME COMPLETED:
08:13 PM
ALLEGATION(S):
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2
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9
Unqualified staff teaching children at facility
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 are teaching children at the facility.

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 allegation that staff are unqualified, stating that Staff 3 (S3), Director (D1) and herself are the qualified teachers.

Six staff (S1-S6) were interviewed on 04/15/21, 04/20/21, 04/21/21, 04/23/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received from L1 on 05/04/21 and 5/18/21. Based on interviews and a review of records, LPA did not have sufficient evidence to proof that the toddler room or preschool room was ever without one fully qualified teacher.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
VISIT DATE: 08/03/2021
NARRATIVE
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2021
Section Cited
CCR
101170(e)(2)
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Criminal Record Clearance(e) ...prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f).
This requirement is not met as evidenced by:
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L1 stated that A1 was associated to the facility on 05/04/21 and S6 although not currently working at the facility will be associated prior to returning to work for the facility.
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Based on staff interviews and record review A1 and S6 were working and not associated to the facility and a transfer request was not completed which poses a potential safety risk to the children in care.

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Type B
08/04/2021
Section Cited
CCR
101216.3(b)(1)
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(b)The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1)A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).
This requirement is not met as evidenced by:
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L1 stated that she is hiring new staff and will have two teachers in each classroom and one aide, providing incentives to the aides to obtain 6 units in ECE, by utilizing the R&R and paying for any remaining costs.
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Based on staff interviews the preschool has had more than 15 children, and up to 20 children in care on more than one occasion with one qualified teacher and 1 or two aides that do not hold units in Early Childhood Education. 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
Section Cited
CCR
101239(e)(4)
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101239 Fixtures, Furniture, Equipment and Supplies (e) Faucets used by children for personal care shall deliver hot water. (4)All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition…
This requirement is not met as evidenced by:
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L1 stated that on 04/21/21 the hot water was disconnected and the water no longer smells of rotten eggs.

During the inspection LPA confirmed that the water had no odor.
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Based on interviews with L1 and S1-S3 and S5-S6, the hot water heater in the school age room has an issue that causes the sink water to smell like rotten eggs, and the preschool children use the school age bathroom sink when playing outside to wash their hands. 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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: 2 of 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2021
Section Cited
CCR
101223(a)(3)
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Personal Rights. 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 eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by:
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L1 stated that D1 was fired 04/16/21 and will not allow D1 to return to the facility. L1 stated that they conducted a staff training on personal rights with staff on 04/25/21. 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 D1 pull on the arms of multiple children on more than one occasion, handling the children in care roughly. This poses an immediate health and safety risk to the children in care.
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Type A
08/04/2021
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds (a)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by:
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L1 stated that on 04/22/21 L1 had her husband bring in a large magnetic roller to pick up any metal objects from the play yards. L1 stated that no nails or screws have been found since. L1 stated the yard is scanned daily for safety.
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Based on staff interviews, on more than one occasion rusty nails and screws were found by children on the playground after it was brought to L1’s attention. 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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: 7 of 8
Control Number 01-CC-20210412095247
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
FACILITY NUMBER: 493009958
VISIT DATE: 08/03/2021
NARRATIVE
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All staff interviewed stated that the preschool children use the school age bathroom sink when playing outside on a daily basis, corroborating that the sink water smelled so strongly of rotten eggs that it made you gag, stating that children did not what to wash their hands using the water.

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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
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: 3 of 8