233009794-6-24-2019-01-CC-MTRH-BDFSAE-20190624134213

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 233009794
Report Date: 06/13/2019
Date Signed: 06/24/2019 01:42:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	BOONT TRIBE COMMUNITY SCHOOL P/S		FACILITY NUMBER:	233009794
ADMINISTRATOR:	SEASHA ROBB		FACILITY TYPE:	840
ADDRESS:	8300 HIGHWAY 128		TELEPHONE:	(707) 895-3590
CITY:	PHILO	STATE: CA	ZIP CODE:	95466
CAPACITY:	14	CENSUS:	DATE:	06/13/2019
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:			TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A pre-licensing inspection visit was conducted on 4/15/2019 by LPA, M. Trinh. The Preschool will use same building and playground as the School -Age Center with (Facility # 233009444). The applicant is requesting a license for a capacity of 14 Preschool children (ages 3 to 5). Services will be provided 6am - 6pm. Only on Fridays. The facility appears to be clean and orderly and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. No poisons are kept in facility. The applicant reports there are no weapons in the facility and none were observed during the visit. The children in care will have access to age appropriate toys and equipment. The facility is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. The heater is securely screened. The children will use the backyard as the outdoor play area. The backyard is completely fenced or the backyard is not completely fence, therefore, the applicant understands that constant supervision must be provided while children are outside. There is no trampoline on the premises. There is no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are posted. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid. The applicant shall be present and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. Continued...

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BOONT TRIBE COMMUNITY SCHOOL P/S	FACILITY NUMBER: 233009794
	VISIT DATE: 06/13/2019

NARRATIVE

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The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited during the hours of operation in those areas where children are present.
Fire clearance was granted by Anderson Fire Department on 5/22/2019.
The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a day care center. Forms and regulations must be obtained from the website. http://ccld.ca.gov/
Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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 http://www.ada.gov/childqanda.htm.
This report, as well as the Safe Sleep Concepts and Effects of Lead Exposure brochure were reviewed and discussed with the applicant. All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The facility is ready for licensure as of 6/13/2019.
This report will be mailed to applicant, Seasha Robb for signature.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019

LIC809 (FAS) - (06/04)

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