343624251-5-27-2022-03-CC-ATIY-CETQ6J-20220527115336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624251
Report Date: 05/27/2022
Date Signed: 05/27/2022 11:53:53 AM

Document Has Been Signed on 05/27/2022 11:53 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:	05/27/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ashley Teeney		TIME COMPLETED:	12:15 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 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. During today’s inspection, Applicant was hosting an open house. 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. LPA 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 and 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). Infant Room 1, Infant Room 2 and Toddler Room 1 are equipped with sufficient amount of infant size furnishing and a variety of age- appropriate toys that appear to be in good repair. Toddler Room #2 is empty. Applicant will purchase more cubbies. LPA observed 8 cribs and 18 cots. Applicant will purchase more cots to accommodate the rest of the infant children who are not in cribs. Applicant acknowledges 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. The napping area is in Infant Room #2. (Report continued on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: 05/27/2022

NARRATIVE

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There is a first aid kit in each of the classrooms. There is a lock box in each classroom for children medications. Cleaning disinfectants are appropriately stored in a higher cabinet in the classrooms and inaccessible to children. Applicant stated there are no firearms or poisons on the premises. LPA observed water pitchers in each classroom, for 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 (one in the office and the two outside bathrooms). LPA observed two 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 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 observed a variety of age-appropriate outdoor toys and equipment. 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. LPA received a waiver request from Applicant. 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. AS 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: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: 05/27/2022

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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.

Applicant 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.

A Provisional License is granted today, 05/27/2022 pending the following items:

- Purchase sufficient amount of cots, cubbies, changing tables
- Toddler Room 2: set up and make operation ready
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: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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