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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500865
Report Date: 06/12/2023
Date Signed: 06/12/2023 11:31:18 AM

Document Has Been Signed on 06/12/2023 11:31 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:TREEHOUSE CHILDRENS CENTERFACILITY NUMBER:
574500865
ADMINISTRATOR:PECKHAM, JENNIFERFACILITY TYPE:
840
ADDRESS:418 HAVEN STTELEPHONE:
(916) 878-0585
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 7DATE:
06/12/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer PeckhamTIME COMPLETED:
10:45 AM
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Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Jennie Tedlos met with Applicant Jennifer Peckham for the purpose of an announced second pre-licensing change of ownership inspection due to applicant making changes to the school-age schedule. Applicant requests a school-age license to serve 30 school-age children from kindergarten and above. The program will operate during the summer only, Monday through Friday from 8:30 a.m. to 4:30 p.m. The fire clearance was granted and received on 5/12/2023. The facility will be providing morning and afternoon snacks during the summer.

Exit interview conducted and report was reviewed with the applicant Jennifer Peckham.

The following items are required before a license will be issued:
1. Remaining paperwork listed on LIC184
2. Final file review from Licensing Program Manager (LPM)
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
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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