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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009444
Report Date: 02/10/2022
Date Signed: 02/10/2022 03:12:26 PM

Document Has Been Signed on 02/10/2022 03:12 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BOONT TRIBE COMMUNITY SCHOOL S/AFACILITY NUMBER:
233009444
ADMINISTRATOR:ROBB, SEASHAFACILITY TYPE:
840
ADDRESS:8300 HWY 128TELEPHONE:
(707) 533-5094
CITY:PHILOSTATE: CAZIP CODE:
95466
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
02/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Seasha RobbTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Director, Seasha Robb to conduct a case management inspection. The facility is adding a classroom to the school age license. The facility is church with two classrooms. The addition is the Sanctuary Room at the front of the church/center.

The square footage of the interior and exterior is sufficient to support the current capacity.

There is a single non-gender bathroom with one toilet and one sink for the school age children. This bathroom was the staff bathroom. The facility will acquire a portable toilet that will be position outside of the building for staff use. The director agrees to send the department a photo of the toilet once it has been delivered.

CCLD will submit a request to the local fire inspector to inspect the facility due to the room addition. The room will be approved for use upon receipt of the approved fire clearance and photo of the installed portable toilet for staff.

No deficiencies cited during the inspection.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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