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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615921
Report Date: 07/10/2023
Date Signed: 07/10/2023 11:49:40 AM


Document Has Been Signed on 07/10/2023 11:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:TREE HOUSE CHILDREN'S CENTER, THEFACILITY NUMBER:
573615921
ADMINISTRATOR:MILLER, JILLIANFACILITY TYPE:
840
ADDRESS:418 HAVEN STREETTELEPHONE:
(530) 795-0123
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY:45CENSUS: 7DATE:
07/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer Peckham and Janet AndersenTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Lauren Scott and Jennie Tedlos met with future director, Jennifer Peckham and current director, Janet Andersen for the purpose of a case management. Facility is doing a change of ownership that will take place this month. The facility's new facility number will be 574500865.

No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2023
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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