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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624251
Report Date: 07/01/2025
Date Signed: 07/01/2025 12:43:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2025 and conducted by Evaluator Andrea Cortez
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20250414224158
FACILITY NAME:MINDFUL MOMENTS, INC.FACILITY NUMBER:
343624251
ADMINISTRATOR:SIMMONS, TIFFANYFACILITY TYPE:
830
ADDRESS:750 N STREETTELEPHONE:
(916) 626-2739
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:56CENSUS: 6DATE:
07/01/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ashley WinnTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Personal Rights- Staff vaping on the facility grounds while daycare children are present.
INVESTIGATION FINDINGS:
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On 07/01/2025 at approximately 9:45 AM, License Program Analysts (LPAs) Andrea Cortez and Pa Dao Vang conducted an unannounced complaint inspection to deliver findings on the above-mentioned allegation. LPA Dao observed infant-to-staff ratio of 6:3 while LPA Andrea was setting up to meet with the Licensee Ashley Winn. LPAs explained the purpose of our inspection and allegation of staff vaping on the facility grounds while daycare children are present.

During the complaint investigation, LPA observed the infant room in ratio and staff members interacted with children, obtained teachers and children rosters to prepare for investigation. LPA interviewed parents and staff members. According to the parent and staff interviews, there was insufficient evidence to support the allegation listed above.

Continued page LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 03-CC-20250414224158
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 MOMENTS, INC.
FACILITY NUMBER: 343624251
VISIT DATE: 07/01/2025
NARRATIVE
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Therefore, although the alleged violation may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that it did or did not occur, therefore they are unsubstantiated. There is no deficiency issued today. An exit interview was conducted, notice of site visit, and appeal rights were provided to Licensee Ashley Winn. Notice of site visit will be posted for 30 consecutive days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2