343622855-4-25-2024-03-CC-DVAG-D4NQNW-20240425121950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622855
Report Date: 04/25/2024
Date Signed: 04/25/2024 12:20:00 PM

Document Has Been Signed on 04/25/2024 12:20 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:	343622855
ADMINISTRATOR/ DIRECTOR:	TEENEY, ASHLEY		FACILITY TYPE:	850
ADDRESS:	1001 I STREET		TELEPHONE:	(916) 889-3443
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 32	DATE:	04/25/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Teeney, Ashley		TIME VISIT/ INSPECTION COMPLETED:	12:45 PM

NARRATIVE

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At 9:30 a.m. on Thursday, April 25th, 2024, Licensing Program Analyst (LPAs) Pa Dao Vang and Fabian Schwartz met with Licensee Ashley Teeney and Director Jennifer Ortiz for the purpose of an unannounced, required – 3 year inspection. LPA observed a census of 32 preschool children supervised by 5 staff. Facility hours of operation are from 7:00 a.m. - 6:00 p.m., Mondays thru Fridays.

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.

LPAs 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.

Center offers two snacks for children in the morning and afternoon along with lunch. Breakfast is also provide with extra costs. Other food in the facility was stored to prevent contamination in the fridge located in the kitchen. Facility utilizes an electronic sign in and sign out program to sign children into the facility daily.

All furnishings were in good condition. Toys are appropriate size with no small parts for the safety of preschool.

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. LPAS observed current medication stored in the classroom's cabinet.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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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Document Has Been Signed on 04/25/2024 12:20 PM - It Cannot Be Edited

Created By: Dao Vang On 04/25/2024 at 11:38 AM

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: 343622855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 5 staff missing MMR in personnel files, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/27/2024
	Plan of Correction
1 2 3 4	Licensee will obtain the MMR from staff and email LPA Vang.

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: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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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: 343622855
	VISIT DATE: 04/25/2024

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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 water bottles.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunization, 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 2 out 5 staff missing MMR in their personnel files.

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. A copy of this report and appeal rights were discussed and left with Licensee Ashley Teeney. 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: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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