313620421-5-9-2019-03-CC-JMCN-BC23W6-20190509183614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313620421
Report Date: 05/09/2019
Date Signed: 05/09/2019 06:36:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	KNOWLEDGE TREE CHILDREN'S ACADEMY		FACILITY NUMBER:	313620421
ADMINISTRATOR:	PAGE, CRYSTAL		FACILITY TYPE:	840
ADDRESS:	1100 SUNSET BLVD		TELEPHONE:	(916) 435-9382
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	28	CENSUS: 0	DATE:	05/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cheylynne Shingoitewa and Wen Ma		TIME COMPLETED:	01:45 PM

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Licensing Program Analysts (LPA) Jeremey McClain and Jan Hoshida, met with Assistant Cheylynne Shingoitewa and Owner Wen Ma for the purpose of an unannounced annual random inspection. No school age children were present during the time of inspection. Facility hours of operation are Monday through Friday from 6:30 AM to 6:00 PM.

LPAs toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are appropriately stored and inaccessible to children. Director stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides morning snacks, lunch, and afternoon snacks. Menus were posted and drinking water was readily available to children both indoors and outdoors. The facility currently uses an electronic sign-in/sign-out system.

Staff and children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility has a criminal record clearance, health screening report, Mandated Reporter training certificates, and documentation of their educational background, training, and/or experience. There are no firearms or bodies of water on the premises.

REPORT CONTINUED ON THE FOLLOWING PAGE...

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KNOWLEDGE TREE CHILDREN'S ACADEMY	FACILITY NUMBER: 313620421
	VISIT DATE: 05/09/2019

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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.

Assistant Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

This facility evaluation report was reviewed and discussed with the Assistant Director and Owner.

A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019

LIC809 (FAS) - (06/04)

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