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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009444
Report Date: 09/12/2024
Date Signed: 09/12/2024 02:01:59 PM

Document Has Been Signed on 09/12/2024 02:01 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BOONT TRIBE COMMUNITY SCHOOL S/AFACILITY NUMBER:
233009444
ADMINISTRATOR/
DIRECTOR:		ROBB, SEASHAFACILITY TYPE:
840
ADDRESS:8300 HWY 128TELEPHONE:
(707) 513-8020
CITY:PHILOSTATE: CAZIP CODE:
95466
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 10DATE:
09/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:52 AM
MET WITH:Seasha RobbTIME VISIT/
INSPECTION COMPLETED:
12:11 PM
NARRATIVE
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Licensing Program Analyst (LPA), Robert Maciel made an unannounced Plan of Correction (POC) visit and met with Director, Seasha Robb (S1), for the purpose of following up on outstanding POCs that were due by 01/30/2024. During the annual inspection on 01/09/2024, the facility was cited three violations which include the facility not yet having its its drinking water tested for lead contamination levels, the facility not performing a disaster drill within the last 6 months, and not possessing current mandated reporter training certificates for the Director or staff 2 (S2).

During today's visit, LPA observed 10 children in care. LPA requested facility and children's records. Director stated she had not yet had faucets used for drinking or food preparation tested for lead, did not record a disaster drill within the last 6 months, and did not possess current mandated reporter training certificates for herself or S2.

The following violations of the California Code of Regulations Title 22 were cited. Please see LIC809-D. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Seasha Robb.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 09/12/2024 02:01 PM - It Cannot Be Edited


Created By: Robert Maciel On 09/12/2024 at 01:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BOONT TRIBE COMMUNITY SCHOOL S/A
FACILITY NUMBER: 233009444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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Director stated that she would have the faucet in the kitchen tested for lead according to the written directives in PIN 21-21.1 and send completed forms to LPA by email at robert.maciel@dss.ca.gov.
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Based on interview, water fountains used for drinking or food preparation were not tested for lead contamination which poses a potential health, safety or personal rights risk to persons in care.
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Type B
09/26/2024
Section Cited
CCR101174(d)

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(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
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Director stated she would perform a disaster drill, record it, and send a picture of the record to LPA by email at robert.maciel@dss.ca.gov
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Based on interview, the director did not conduct a disaster drill within the past 6 months which poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/12/2024 02:01 PM - It Cannot Be Edited


Created By: Robert Maciel On 09/12/2024 at 01:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BOONT TRIBE COMMUNITY SCHOOL S/A
FACILITY NUMBER: 233009444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
HSC
1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
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Director stated she would send a photograph of S1 and S2's mandated reporter training certificate to LPA by email at robert.maciel@dss.ca.gov.
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Based on record review, the director (S1) and staff 2 (S2) did not possess current mandated reporter training certificates which poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024


LIC809 (FAS) - (06/04)
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