343624251-5-19-2022-03-CC-ATIY-CEKQ92-20220519115736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624251
Report Date: 05/19/2022
Date Signed: 05/19/2022 11:57:49 AM

Document Has Been Signed on 05/19/2022 11:57 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	MINDFUL MOMENTS, INC.		FACILITY NUMBER:	343624251
ADMINISTRATOR:	TEENEY, ASHLEY		FACILITY TYPE:	830
ADDRESS:	750 N STREET		TELEPHONE:	(707) 583-3333
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 56	CENSUS: 0	DATE:	05/19/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ashley Teeney and Jarred Winn		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Alize Tillery met with Applicant Ashley Teeney and Jarred Winn for the purpose of an announced pre-licensing inspection. Applicant requests an infant license to serve 56 infant children from birth to age two years. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 05/18/2022. Program will not provide transportation services. AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. Applicant stated the facility will provide breakfast a snack for infants who are transitioning to solid food. Applicant stated parents will provide milk and formula for the younger infants. INDOOR ACTIVITY SPACE: There are four infant classrooms: Infant Room 1 (ages 0-2), Infant Room 2 (napping room), Toddler Room 1 (ages 1-2) and Toddler Room 2 (ages 1-2). The classrooms is not equipped with sufficient amount of infant size furnishing, sufficient number of cubbies, and a variety of age- appropriate toys that appear to be in good repair; Applicant stated these items are in storage and will be brought to the classrooms today and tomorrow. LPA did not observe any cribs. Applicant purchased 8 cribs while LPA was present. Applicants acknowledge there will be a maximum of 8 infants under 12 months old, due to available cribs. The infant napping area is physically separate from the activity space. (Report continued on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MINDFUL MOMENTS, INC.	FACILITY NUMBER: 343624251
	VISIT DATE: 05/19/2022

NARRATIVE

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There is no first aid kit on the premises; Applicant stated the kit is also in storage. Applicant stated that medication will be stored in a locked box in the classrooms. Applicant stated that cleaning disinfectants will be kept in the classrooms in higher cabinets, out of children’s reach. Applicant stated there are no firearms or poisons on the premises. Applicant stated drinking water for indoor and outdoor will be provided via water pitcher and children’s personal cups. LPA observed functional carbon monoxide detectors, smoke detectors and fire extinguishers throughout the facility. Applicant stated that that they will use the brightwheel app for electronic sign in and out.

LPA measured the classrooms. The total classroom space contains a total of 2,790 square feet, which will accommodate Applicant's requested capacity for 56 infant children. The facility has a total of 25 sinks and 11 toilets available for children. There is a separate staff restroom available. LPA did not observe changing tables with a changing pad that is at least one inch think with raised sides that are at least three inches tall within arm’s reach of a sink; Applicant stated that these items are in storage and will be brought to the facility today and tomorrow. Applicant stated children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area that is separate from the preschool outdoor activity space. The outdoor play area is surrounded by a fence that is at least four feet tall. LPA did not observe a variety of age-appropriate outdoor toys and equipment; Applicant stated that these items are in storage. The playground is shaded by a sail canopy.

LPA measured the outdoor activity space. The outdoor play area contains a total of 1,226 square feet, which does not accommodate the applicant's requested capacity of 56 infant children. The total square footage allows up to 16 infant children. Applicant will submit a playground waiver request and sample schedule to LPA. Applicant stated drinking water will be readily available and accessible via water pitcher and personal cups.

LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MINDFUL MOMENTS, INC.	FACILITY NUMBER: 343624251
	VISIT DATE: 05/19/2022

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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 athttps://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.

Applicant was 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.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MINDFUL MOMENTS, INC.	FACILITY NUMBER: 343624251
	VISIT DATE: 05/19/2022

NARRATIVE

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The following items are required before a license will be issued:

1. Updated LIC 200A

2. LIC 308

3. LIC 500

4. Director Qualifications

5. Job Descriptions

6. Parent Handbook

7. Admission Agreement

8. Sample Menu

9. Licensee Representative documentation

10. Required postings

11. Equipment: toys, tables, chairs, cubbies, napping mats/cots, cribs

12. Outdoor play equipment

13. First aid kit

14. Trash bins with tight fitted lids

15. Outdoor playground waiver

16. Pending Licensing Program Manager Seychelle De Luca’s final review

Exit interview conducted and report was reviewed with Applicant, Ashley Teeney.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

LIC809 (FAS) - (06/04)

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