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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010900
Report Date: 09/22/2025
Date Signed: 09/22/2025 12:46:53 PM

Document Has Been Signed on 09/22/2025 12:46 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTERFACILITY NUMBER:
493010900
ADMINISTRATOR/
DIRECTOR:		JEANETTE BOEHMFACILITY TYPE:
860
ADDRESS:530 N CLOVERDALE BLVDTELEPHONE:
(707) 318-3951
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY: 35TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
09/22/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Jeanette BoehmTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 09/22/2025, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Jaelyn Agbayani met with the Licensee Representative Jeanette Boehm. The purpose of the visit was an unannounced pre-licensing inspection at the facility to ensure the health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. The facility has an existing preschool license with a toddler component Facility # 493009958 with a capacity of 40, 18 of which are toddlers ages 18 to 36 months and 22 of which are preschool children ages 2 years old to entry into first grade. Upon completion of the inspection process this facility license will convert to a single license facility # 493010900 that contains an addition of an infant component. Applicant is requesting to be licensed for 5 infants (ages 0-24 months) in the infant room Area 1 and Area 2 that contain a wall divider splitting the large room into two sections, 12 toddlers (ages 18-36 months) in the toddler room Area 1 and Area 2 that also contains a wall divider splitting the large room into two sections, and 18 preschoolers (2 years old to entry into first grade) in preschool classrooms 1 and 2 from Mondays to Fridays 7:00 AM to 5:30 PM. The fire clearance was granted on 06/06/2025 by the Cloverdale Fire Department. During today’s visit, there were 7 children present with sufficient amount of staff to accommodate to the necessary ratio requirement.

LPA toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 3 large classrooms that contain wall dividers splitting each room into 2 sections. Ultimately the facility has 5 activity rooms and 1 crib room for the infants.

Infant Classroom measurements are:
The indoor total measurements contain a total of 221.9 square feet, which will accommodate applicant’s request for 5 infants.
Report continued on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Jaelyn Agbayani
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 493010900
VISIT DATE: 09/22/2025
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Toddler Classroom measurements are:
The indoor total measurements contain a total of 438.57 square feet, which will accommodate applicant’s request for 12 toddlers.

Preschool Classroom measurements are:
The indoor total measurements contain a total of 769.39 square feet, which will accommodate applicant’s request for 18 preschool children.

Infant Outdoor Play measurements are:
Outdoor total measurements contain a total of 733.38 square feet, which will accommodate applicant’s request for 5 infants.

Toddler Outdoor Play measurements are:
Outdoor total measurements contain a total of 2280.85 square feet, which will accommodate applicant’s request for 12 toddlers.

Preschool Outdoor Play measurements are:
Outdoor total measurements contain a total of 3024.33 square feet, which will accommodate applicant’s request for 18 preschool children.

All indoor and outdoor activity space utilized for the children were inspected today. LPA informed applicant that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. Classrooms were observed to be clean, safe, sanitary and in good repair. All outdoor and indoor passageways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times.

Furniture and equipment were observed to be maintained in good condition, free of sharp, loose, or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age appropriate. Tables and chairs were observed to meet the needs of the children. There are 36 chairs, 11 tables, 24 cots, 2 changing mats, 3 cribs, 2 high chairs, 3 infant feeding chairs, 40 hooks, 4 toilets, 6 sinks, and 40 cubbies available for infant, toddler, and preschool children. Isolation area for sick children will be the staff room or director office, children have access to the staff bathroom and remain separated from remaining children. If a sick child does use the children’s restroom, the staff do ensure that the bathroom is deeply sanitized after usage.
Report continued on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Jaelyn Agbayani
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 493010900
VISIT DATE: 09/22/2025
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Facility has two infant, two toddler, and two preschool classrooms. The infant’s do contain a separate room for cribs. Applicant stated that facility will provide snacks and lunch for children in care. Applicant stated that parents will provide bottles for infants under 1 and infants who are able to eat solid foods will be provided snack and lunch by the facility. LPA advised Applicant that as per Title 22 regulations, bottles and dishes shall be rinsed for sanitizing at the end of each day.

The Applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight-fitting cover that is kept on. LPA observed no fireplace or open face heaters. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. There is a fully equipped first aid kit located in the staff room. There is an operational carbon monoxide detector on site. A separate staff bathroom is available.

LPA observed the facility has refrigerator and microwave in the premises. Drinking water is readily available for the children in the facility via refrigerator dispenser. Applicant stated that children bring their own water bottles.

LPA observed the facility has fully fenced outdoor playgrounds with separate areas for infants, toddlers, and preschool children. Outdoor areas were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. Any construction or equipment that could pose a hazard in the outdoor activity areas shall be made inaccessible to children in care. The preschool yard has shade provided via a large tree, the toddler yard has shade via an awning and a popup tent, and the infant yard is provided shade via a gazebo/building overhang. The playground is enclosed by a fencing at least 4 feet high. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in fall zones provide woodchips that can absorb a fall. The infant yard contains adequate cushioning in fall zones provided by infant mats surrounding the infant climbing structure. LPA advised Applicant that sandboxes shall be inspected daily and kept free of hazardous foreign materials. LPA observed no bodies of water.

Report continued on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Jaelyn Agbayani
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 493010900
VISIT DATE: 09/22/2025
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Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. If the facility has had a lead test completed within the last five years from the pre-licensing visit date (09/22/2025) and is using the same outlets, you may submit a waiver request from the lead testing requirement to the Regional Office.

Jeanette was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with licensee representative the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with licensee representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Jeanette Boehm of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Report continued on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Jaelyn Agbayani
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CLOVERDALE EAGLETS PRESCHOOL & DAYCARE CENTER
FACILITY NUMBER: 493010900
VISIT DATE: 09/22/2025
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Jeanette was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given to the licensee representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

An exit interview was conducted.

A copy of appeal rights and this report was provided to the licensee representative, Jeanette Boehm.

The following corrections are needed before a licensure will be considered:
1. Final review of application packet by LPM
2. Add child lock knobs to stove

Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Jaelyn Agbayani
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC809 (FAS) - (06/04)
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