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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624251
Report Date: 08/22/2022
Date Signed: 08/22/2022 11:02:13 AM

Document Has Been Signed on 08/22/2022 11:02 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, ASHLEYFACILITY TYPE:
830
ADDRESS:750 N STREETTELEPHONE:
(707) 583-3333
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 18DATE:
08/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ashley TeeneyTIME COMPLETED:
11:30 AM
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On 8/22/2022, Licensing Program Analyst (LPA) Alize Tillery conducted a case management visit, for the purpose of issuing a regular license to the facility. LPA met with Director, Ashley Teeney. The program has been operating as a provisional license effective 5/27/2022. During today's inspection, LPA observed 18 infant children, supervised by 6 staff members.

Program was pending licensure due to insufficient amount of equipment, cots, cubbies and changing tables. During todays inspection, LPA observed enough cots, cubbies and changing tables for the requested capacity amount of 56. LPA observed 20 cribs in the Infant Room #2 (napping room) with mattresses and tight fitted sheets. LPA informed Director that children must submit an exemption request prior to using sleeping sacks or suits.

All active rooms (Infant Room 1, Toddler Room 1 and Toddler Room 2), are fully furnished, provide safe and age appropriate equipment and toys and are operational ready.

Effective today, 8/22/2022, the facility is licensed for 56 infants, with no more than 20 infants under the age of 12 months, due to the available cribs.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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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