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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009794
Report Date: 06/21/2021
Date Signed: 06/22/2021 11:48:55 AM

COMPREHENSIVE INSPECTION
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/SFACILITY NUMBER:
233009794
ADMINISTRATOR:SEASHA ROBBFACILITY TYPE:
850
ADDRESS:8300 HIGHWAY 128TELEPHONE:
(707) 895-3590
CITY:PHILOSTATE: CAZIP CODE:
95466
CAPACITY:14CENSUS: 4DATE:
06/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Seasha RobbTIME COMPLETED:
02:45 PM
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An annual inspection was made to the facility by Licensing Program Analyst (LPA), Mary Trinh. The facility file was reviewed 06/21/2021. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. (This program is operated by private entity).
The facility’s operating hours are 9:00 am to 5:00 pm, Friday. (This week is Summer Camp which is 9 am to 5 pm, M-F). The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. No Poisons are kept in facility. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There are wood chips cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Licensee/ Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 4 children were being supervised by Licensee. The facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications with expiration date of Nov 2022. The sign-in/sign-out procedure was reviewed and in compliance. (4) children’s records were reviewed at 1:50 pm, and contained signed admission agreements. (3) staff records were reviewed at 2:00 pm and contained documentation of education and training as required. This facility is not providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director. (LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.) For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.
There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary TrinhTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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