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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620420
Report Date: 05/30/2024
Date Signed: 05/30/2024 10:15:52 AM

Document Has Been Signed on 05/30/2024 10:15 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KNOWLEDGE TREE CHILDREN'S ACADEMYFACILITY NUMBER:
313620420
ADMINISTRATOR/
DIRECTOR:		ERICA VANTONGERENFACILITY TYPE:
850
ADDRESS:1100 SUNSET BLVDTELEPHONE:
(916) 435-9382
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 116TOTAL ENROLLED CHILDREN: 116CENSUS: 33DATE:
05/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Erica VantongerenTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPAs) Jeremey McClain and Katrina Owens met with facility representative Erica Vantogeren for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPA observed 33 preschool and toddler children, supervised by eight staff members.

It was reported that on 05/22/2024, a child suffered a broken elbow while in care. The child tripped off a small crate on the playground. During today’s inspection, LPA reviewed footage of the incident, interviewed staff that witnessed the injury, and observed the playground and equipment. LPA discussed safety precautions with facility representative. LPA determined that the injury was not due to lack of supervision nor hazardous conditions that could have been prevented.

An exit interview was conducted, and this report was reviewed with facility representative Erica Vantogeren. A Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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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