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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009958
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:50:57 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
04/13/2021 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210413084653
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: 17DATE:
08/04/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jeanette BoehmTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff yells at children
Authorized Representatives are not being communicated to about incidents
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 staff yells at children and
Authorized Representatives are not being communicated to about incidents.

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 confirmed the allegation that staff yells at children, stating that a former staff, D1 was yelling at the children. L1 denied the allegation that authorized representatives are not being communicated to about incidents, stating that when there is an incident, the parents are always told.

Continue on LIC9099-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 6
Control Number 01-CC-20210413084653
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: 08/04/2021
NARRATIVE
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Five staff (S1-S3 and S5-S6) were interviewed on 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21. All staff interviewed corroborated that former staff, D1 yelled at the children in care on more than one occasion. Staff interviewed stated that L1 told staff that they were not allowed to communicate with the children’s Authorized Representatives and that it was her job to do so. Staff corroborated that L1 was often not present at the facility and therefore did not know when an incident between children had occurred, specifically stating that Child 12 (C12) in the toddler room was hitting and pinching other children and L1 was not communicating to C12’s authorized representatives. Staff stated that L1 was told about the incidents involving C12’s behavior on more than one occasion before L1 communicated to C12's parents and they came up with a plan to help with C12's behavior, stating this was after C12 scratched a child, Child 13 (C13) in the face.

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: 2 of 6
Control Number 01-CC-20210413084653
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: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2021
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 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 on more than one occasion, yelled at children in care. 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: 3 of 6
Control Number 01-CC-20210413084653
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: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
Section Cited
CCR
101226(a)(2)
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(a)The licensee shall immediately notify the child's authorized representative…(2)In the case of less serious injuries including, but not limited to, minor cuts, scratches…the licensee shall document the injury in the child's record and notify the child's authorized representative of the nature of the injury when the child is picked up from the center.
This requirement is not met as evidenced by:
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L1 stated that she has used text messages to communicate to parents or spoken to parents after staff are not present and staff are not aware of the communication. L1 stated that beginning 08/04/21 L1 will use the Brightwheel program to record "boo-boo reports" so that teachers can observed reports and also record any incidents that they observe.
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Based on staff interview, L1 has instructed staff that they may not communicate with children’s authorized representative’s, injuries have occurred, and L1 was not present at the facility to report the incident or chose not to report an incident to a child’s authorized representative. This poses a potential health and safety risk to the children in care.
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L1 stated that each child's authorized representative has access to their child's profile on Brightwheel.
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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 6
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
04/13/2021 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210413084653

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:
08/04/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jeanette BoehmTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
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Children are not being supervised adequately
Children are being forced to eat
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 children are not being supervised adequately and that children are being forced to eat.

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 children are not being supervised adequately and that children are being forced to eat, stating that there has never been a time that children in care are not supervised and that the children are not forced to eat.

Five staff (S1-S3 and S5-S6) were interviewed on 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21. Staff interviewed did not corroborate that there was ever a time that the children were left unsupervised but did express concern that the staff supervising the children were not always qualified staff.
Continue on LIC9099-C
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 6
Control Number 01-CC-20210413084653
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: 08/04/2021
NARRATIVE
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Staff interviewed stated that although some staff have told the children that they need to eat their food, no child was ever physically forced to eat while in care.

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 6