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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009794
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:27:35 PM

Document Has Been Signed on 12/03/2024 03:27 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:BOONT TRIBE COMMUNITY SCHOOL P/SFACILITY NUMBER:
233009794
ADMINISTRATOR/
DIRECTOR:		SEASHA ROBBFACILITY TYPE:
850
ADDRESS:8300 HIGHWAY 128TELEPHONE:
(707) 895-3590
CITY:PHILOSTATE: CAZIP CODE:
95466
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/03/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:09 PM
MET WITH:Seasha RobbTIME VISIT/
INSPECTION COMPLETED:
03:37 PM
NARRATIVE
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Licensing Program Analyst (LPA), Robert Maciel made a case management inspection and met with Director Seasha Robb (D1). The inspection was made in response to water lead testing results uploaded to the California State Water Resource Control Board on 11/18/24 showing that the following faucet, tested above the allowable level (5 ppb) of lead in the water: Faucet “A” – Sink Faucet, in the kitchen, tested at 8.7 ppb. Because there is only one faucet, the lead test results uploaded to the California State Water Resource Control Board are only assigned to the School Age facility (#233009444). Both licenses use the same faucet though. On 10/24/24 D1 emailed LPA Maciel, informing him that her recent lead test came back with an ALE and stated that she was going to remediate by replacing the faucet and would start using bottled water.

During today’s inspection, LPA observed that the faucet was replaced. D1 stated that the faucet has been replaced and that she will contact the water testers to re-test the faucet. D1 stated that the children in care are receiving drinking water from bottled water.

The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director Seasha Robb.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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Document Has Been Signed on 12/03/2024 03:27 PM - It Cannot Be Edited


Created By: Robert Maciel On 12/03/2024 at 03:09 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 P/S
FACILITY NUMBER: 233009794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited

101700.3(b)(2)

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Licensees shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.


This requirement was not met as evidenced by:
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D1 has replaced faucet “A” and will reschedule the water tester to retest the faucet and will submit new test results once received. Children receive drinking water from bottles of water. .
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On 12/03/24, licensee failed to maintain a lead value at or below the Action Level for water lead testing resulting with values of 5.5 ppb or greater for Faucet “A” – Sink Faucet, in the kitchen, with a result of 8.7 ppb. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3. are not deemed safe to drink. This is a potential health and safety risk to children in care.
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D1 posted test results on the bulletin board outside of the classroom and will notify all parents and guardians of the steps taken to correct the deficiency.

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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:Erin Virrueta
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


LIC809 (FAS) - (06/04)
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