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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008222
Report Date: 03/10/2022
Date Signed: 03/10/2022 10:17:47 AM

Document Has Been Signed on 03/10/2022 10:17 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BOEHM, JEANETTE FCCHFACILITY NUMBER:
493008222
ADMINISTRATOR:BOEHM, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 318-3951
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:TIME COMPLETED:
10:17 AM
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Case Management – Licensee initiated

Licensing Program Analyst (LPA) Amy Strother spoke with Licensee Jeanette Boehm (L1), over the phone on 11/09/21. L1 stated that she has decided to give up her FCCH license and continue to work in her Child Care Center. LPA requested that L1 mail in her physical license with a written statement on the back stating that she wished to terminate her license as of a specified date and will not be providing child care with signature and date. The physical license was received by the Santa Rosa Regional Office on 03/04/22. Today, a visit was made to L1’s home by LPA Strother to confirm closure.

At 10:02am LPA arrived to the home unannounced. LPA stood at door for a moment prior to knocking and did not hear evidence of children present in the home. LPA knocked on the door, L1's son answered the door stating that L1 was currently not home and working at the preschool and that children don't come to the home anymore. LPA left a business card with L1's son. LPA did not observe children in care during today's visit.

L1 was not available for a signature. No signature is on file.

LPA Strother will process the closure with the effective closure date of October 01, 2021.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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