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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009958
Report Date: 08/04/2021
Date Signed: 08/06/2021 10:26:47 AM

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-20210419111905
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 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
05:30 AM
ALLEGATION(S):
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Facility has pests
Facility has no food menu
Staff are not providing adequate food service to day care children
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 the facility has pests, specifically that rat droppings were found in the outside bathroom and inside the facility and that black widows were found in the toddler area, facility has no food menu, staff are not providing adequate food service to day care children, specifically that expired food is served to the children in care.

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, L1 denied the allegations, stating that there were never any rodent droppings in the school, and although there was a spider, there is no knowledge that it was a black widow, pest services come to the facility monthly, there is a menu on the refrigerator and one is put it on the window of the door but it gets blown away in the wind, and there has never been expired food, shopping is done every weekend at Costco.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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-20210419111905
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 04/20/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21 and 05/18/21. Staff interviewed stated that rodent droppings were found in March of 2020 in the laundry room and the hallway closest to the front door and that black widow spiders were found on the preschool playground, and classroom on an unspecified date, staff stated that L1 was notified and said she would have a pest service come in. Although L1 submitted a menu to LPA on 05/18/21, staff interviews corroborate that they never saw a menu posted prior to late April 2020 and just served what they were told to serve each day. LPA was unable to corroborate that expired food was served to the children in care, however it was corroborated that children are only served milk if they ask for it, corroborating the allegation that adequate food service is not provided.

A review of the records received indicate that the facility received pest control for ants/carpenter bees on 09/21/20, 10/29/20 and 11/30/20, but no services for rodents or spiders. Although L1 submitted a second invoice for pest services including service for spiders, the service address did not match that of the licensed facility.

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.

LPA provided Pest Management Resources to L1 by email during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 01-CC-20210419111905
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
101238(a)(1)
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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. (1) The licensee shall take measures to keep the center free of flies, other insects, and rodents.
This requirement is not met as evidenced by:
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L1 stated that to her knowledge the invoice that stated the facility is serviced for ants/carpenter bees, also includes service for prevention of spiders and a monthly check for possible rodent entry locations around the perimeter of the facility.
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Based on staff interviews rodent droppings and spiders have been observed in the facility in March 2020. Based on record review the facility is serviced for ants/carpenter bees only. This poses a potential health and safety risk to the children in care.
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L1 stated that she doesn't have documentation available at this time but will submit proof of additional services by 09/03/21, to:
amy.strother@dss.ca.gov
Type B
08/09/2021
Section Cited
CCR
101227(a)(6)
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101227(a)...the following shall apply: (6) Menus shall be in writing and shall be posted...in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept...for least 30 days. Menus shall be made available for review...upon request.
This requirement is not met as evidenced by:
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L1 stated that she has a menu that rotates every week, and will start to write the date on the menu each week and hand write in any changes made to the menu as needed then file weekly. L1 stated that she will post the menu in the kitchen and add a copy to the hallway postings.
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Based on staff interviews menus were not posted prior to April 2020. This poses a potential health and safety risk to the children in care.
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L1 will submit a copy of the menu for the week of 08/09/21 to LPA Strother by 08/09/21.

amy.strother@dss.ca.gov
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: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 01-CC-20210419111905
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
08/30/2021
Section Cited
CCR
101227(a)(1)
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101227 (a)...(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified...for the age group served...
This requirement is not met as evidenced by:
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L1 stated she will remind staff on 08/05/21 that milk needs to be served to all children, not just the children that request it, and cover this topic during the staff meeting on 08/29/21. L1 stated that she will purchase a milk alternative such as almond milk for children with milk allergies, beginning 08/09/21.
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Based on staff interviews milk is only served to the children if they request it and a milk alternative is not served to children with milk allergies.This does not meet the requirement for each meal to include milk. This poses a potential health and safety risk to the children in care.
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L1 will submit staff meeting notes to LPA by 08/30/21.
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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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
04/19/2021 and conducted by Evaluator Amy Strother
COMPLAINT CONTROL NUMBER: 01-CC-20210419111905

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 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
05:30 AM
ALLEGATION(S):
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2
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Staff are not properly cleaning 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 staff are not properly cleaning the facility, specifically that the toys are not being cleaned.

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, L1 denied the allegation, stating that the toys are getting cleaned daily, either by staff or L1 cleans them after everyone goes home.

Five staff (S1-S3 and S5-S6) were interviewed on 04/20/21, 04/27/21, 04/28/21, 04/29/21 and 07/22/21. Records were received and reviewed on 05/04/21 and 05/18/21. Staff interviewed were unable to corroborate the allegations that the facility is not properly being cleaned and were able to state examples cleaning that they complete while working.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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-20210419111905
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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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: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6