343622856-4-9-2024-03-CC-DVAG-D46V7W-20240409161150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622856
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:11:59 PM

Document Has Been Signed on 04/09/2024 04:11 PM - 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:	MINDFUL MIRACLE, INC.		FACILITY NUMBER:	343622856
ADMINISTRATOR/ DIRECTOR:	TEENEY, ASHLEY		FACILITY TYPE:	830
ADDRESS:	1001 I STREET		TELEPHONE:	(916) 889-3443
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 19	DATE:	04/09/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Ashley Teeney		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

NARRATIVE

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At 1:00 p.m. on Tuesday, April 9th, 2024, Licensing Program Analyst (LPA) Pa Dao Vang Licensee Ashley Teeney and Director Jennifer Ortiz for the purpose of an unannounced, required – 3 year inspection. LPA observed a census of 19 infants/toddlers supervised by 4 staff. Facility hours of operation are from 7:00 a.m. - 6:00 p.m., Monday thru Friday.

Licensee and Director were reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA conducted a health and safety inspection of the classroom, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Lead Poising information, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Licensee stated that there are no firearms nor poisons on the premises.

Infant formula is provided by parents/guardians. Center offers two snacks for children in the morning and afternoon. Other food in the facility was stored to prevent contamination in the fridge located in the kitchen. LPA observed a gallon of half way and thawed milk stored in the fridge with expiration date of 3/12/2024. There were other frozen gallons of milk with current dates on them. Licensee explained that she’ll buy bulks of milk every 2 weeks and freeze them. They are taken out as needed to thaw for meals. Facility utilizes an electronic sign in and sign out program to sign children into the facility daily.

LPA observed that each child had a Needs and Service plan. LPA observed an Individual Infant Sleep Plan (LOC9227) for each child under 12 months of age. LPA observed documentation that sleep checks were being conducted by staff every 15 minutes for all children under 2 years.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

Document Has Been Signed on 04/09/2024 04:11 PM - It Cannot Be Edited

Created By: Dao Vang On 04/09/2024 at 02:56 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MINDFUL MIRACLE, INC.	FACILITY NUMBER: 343622856
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record reviews, the licensee did not comply with the section cited above in 3 out of 4 staff are missing several required documents in their personnel files, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/10/2024
	Plan of Correction
1 2 3 4	Licensee will email LPA Vang the missing documents to clear the Plan of Correction. LPA provided a business card with contact information to Licensee.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Seychelle De Luca

LICENSING EVALUATOR NAME:

Dao Vang

LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MINDFUL MIRACLE, INC.	FACILITY NUMBER: 343622856
	VISIT DATE: 04/09/2024

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Bottles and baby food were kept in refrigerator inside the kitchen and were properly labeled with the child’s name and date. All furnishings were in good condition. Infant diaper changing area is clean. Changing table was observed to be within arm’s reach from sink. There is a mat for the changing table with vinyl surface that is at least 1 inch think and has raised sides. Toys are appropriate size with no small parts for the safety of infants.

Facility provides Incidental Medical Services. 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: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided an example of the infant sleep log and discussed about the 15 minutes checks for all children under ages 12 months or younger.

LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. Outdoor shade was provided by canopies and buildings. Water is accessible via labeled sippy cups.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunizations, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed 3 out 4 staff missing several required documentation in their personnel files.

Continue report LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MINDFUL MIRACLE, INC.	FACILITY NUMBER: 343622856
	VISIT DATE: 04/09/2024

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Director emailed LPA the lead testing results completed on April 2023 with no exceedance.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A deficiency is being cited based on today inspection in accordance with the California Code of Regulations, Title 22, see LIC809-D. An exit interview was conducted and Plans of Correction were reviewed and developed with the Licensee Ashley Teeney and Director Jennifer Ortiz. A copy of this report and appeal rights were discussed and left with Director Jennifer Ortiz. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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