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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622855
Report Date: 05/01/2025
Date Signed: 06/02/2025 09:34:14 AM

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
03/18/2025 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20250318112818
FACILITY NAME:MINDFUL MIRACLE, INC.FACILITY NUMBER:
343622855
ADMINISTRATOR:JENNIFER ORTIZFACILITY TYPE:
850
ADDRESS:1001 I STREETTELEPHONE:
(916) 889-3443
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:36CENSUS: 21DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff engage in inappropriate behavior in the presence of day care children.
INVESTIGATION FINDINGS:
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On 5/1/2025, at approximately 10:00 AM, Licensing Program Analysts (LPAs) Pa Dao Vang and Fabian Schwartz Fabian met with Director Kochelle (Tiffany) Simmons for the purpose of an unannounced complaint report inspection. The complaint report was submitted to the regional office on 4/21/2025. LPA observed 21 children supervised by 5 during the inspection.

During the inspections of 4/10/2025, 4/24/2025, and 5/1/2025, LPAs made observations, review children’s files, gathered documentation, and conducted interviews. LPAs’ witnessed staff serving meals, putting children to sleep, transitioning children from different environments, and conducting circle times. Based on staff, parents, children, and Licensee’s interviews, LPAs learned there were no staff engaging in inappropriate behaviors in the presence of day care children. There is no violation observed at the facility.

Continue on LC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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-20250318112818
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 MIRACLE, INC.
FACILITY NUMBER: 343622855
VISIT DATE: 05/01/2025
NARRATIVE
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No deficiencies were cited today in accordance with the California Code of Regulations, Title 22. Copy of this report was reviewed and provided to the Director Kochelle (Tiffany) Simmons. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2