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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 03:31:13 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
04/19/2021 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210419104107
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:
03:30 PM
ALLEGATION(S):
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Day care children sleeping arrangement poses as a risk.
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 day care children sleeping arrangements poses as a risk, specifically that the nap mats no not have walking space between them.

During the initial complaint investigation Tele-visit to the facility on 04/29/21, LPA met with L1 using Zoom at 11:52am. During an interview with L1 on 04/29/21, L1 denied the allegations, stating that the allegation isn't true, and that there is plenty of space between the nap mats and the children are arranged sleeping head to toe as the COVID-19 guidance suggests.

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 3
Control Number 01-CC-20210419104107
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. Five of the 6 staff interviewed stated that on more than one occasion the nap mats in the toddler room were not arranged with walking space between them, and sometimes touching each other.

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.

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 3
Control Number 01-CC-20210419104107
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
08/04/2021
Section Cited
CCR
101239.1(d)
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101239.1 Napping Equipment (d) Napping equipment shall be arranged so that each child has access to a walkway without having to walk on or over the cots or mats of other children.
This requirement is not met as evidenced by:
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L1 stated that on 04/29/21 L1 spoke to staff and explained that mats need to be arranged with walking space between them, mats should never block an entrance or exit from the room and children should be on their mats head to toe.

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Based on staff interviews staff corroborate that on more than one occasion the nap mats in the toddler room did not have enough space to walk between them and were sometimes touching. This poses a potential health and safety risk to the children in care.
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During LPA's inspection visit on 08/03/21 and 08/04/21 nap mats were observed to have the required walking space between them and children were placed head to toe.
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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 3