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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009958
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:03:35 PM

Document Has Been Signed on 09/28/2021 03:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
493009958
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
850
ADDRESS:530 NORTH CLOVERDALE BLVDTELEPHONE:
(707) 894-6037
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
09/28/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jeanette BoehmTIME COMPLETED:
03:30 PM
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On 09/28/21 at 11:50am LPA Strother made an unannounced Plan of Correction (POC) visit to the facility. The purpose of today's visit was to clear two citations the facility received during prior visits. On 08/09/21 the facility was cited based on staff interviews during a complaint investigation where staff corroborated that menus were not posted prior to April 2020. During an inspection on 08/18/21 LPA observed that the menus posted were not current. During today's visit on 09/28/21, LPA observed the menu posted was dated 09/27/21, meaning the facility was in compliance, clearing the deficiency.

On 08/04/21 the facility was cited based on staff interviews corroborating 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. During a Plan of Correction inspection on 08/18/21, LPA observed 21 children in care with one teacher and one aide, and was unable to clear the citation from 08/04/21. During today's inspection LPA observed 9 preschool age children in care with one teacher and one aide. The facility was observed to be operating within the staffing and ratio requirements, clearing the deficiency.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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