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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624251
Report Date: 06/17/2025
Date Signed: 06/17/2025 02:55:56 PM

Substantiated


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
05/05/2025 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20250505233101
FACILITY NAME:MINDFUL MOMENTS, INC.FACILITY NUMBER:
343624251
ADMINISTRATOR:SIMMONS, TIFFANYFACILITY TYPE:
830
ADDRESS:750 N STREETTELEPHONE:
(916) 626-2739
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:56CENSUS: DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ashley Winn and Jared WinnTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are leaving a daycare child unattended.
Staff are not following safe sleep practices.
INVESTIGATION FINDINGS:
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On 6/17/2025 at 8:45 AM, License Program Analyst (LPA) Pa Dao Vang and Licensing Program Manager (LPM) Seychelle De Luca conducted an unannounced complaint investigation inspection made to the Regional Office on 5/5/2025. LPA and LPM met with the Licensee Ashley and Jared Winn regarding the above allegations of staff leaving a daycare child unattended and not following safe sleep practices. Upon arrival, LPA observed 5 children supervised by 3 staff.

On 5/13/2025 and today's inspection LPA made observations, conducted interviews, and reviewed documents and the electronic sign-in and out app. LPA reviewed two children’s LIC9227 Infant Safe Sleep Plan from the infant room. One of the forms was not signed by the parent to indicate that child (C1) was able to roll from back to stomach on his own. LPA reviewed the communication app, and on 5/8/2025 at 9:44 AM, LPA observed a photo of C1 sleeping on his stomach. LPA reviewed the communication through the app between a staff and the parent. LPA observed the communication specifying that C1 cannot sleep on the stomach and must be moved to sleep on the back.
Continue on LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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 5
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
05/05/2025 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20250505233101

FACILITY NAME:MINDFUL MOMENTS, INC.FACILITY NUMBER:
343624251
ADMINISTRATOR:SIMMONS, TIFFANYFACILITY TYPE:
830
ADDRESS:750 N STREETTELEPHONE:
(916) 626-2739
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:56CENSUS: DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tiffany Simmons TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are operating out of ratio.
INVESTIGATION FINDINGS:
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On 6/17/2025 at 8:45 AM, License Program Analyst (LPA) Pa Dao Vang and Licensing Program Manager (LPM) Seychelle De Luca conducted an unannounced complaint investigation inspection made to the regional office on 5/5/2025. LPA and LPM met with the Licensee Ashley and Jared Winn regarding the above allegation that the facility operates out of ratio. Upon arrival, LPA observed 5 children supervised by 3 staff.

On 5/13/2025 and today's inspection LPA made observation, conducted interviews, and reviewed documents and the electronic sign-in and out app. LPA witnessed staff supervising children in the infant room with proper ratio. LPA also witnessed staff feeding, putting children to sleep, and engaging in activities with them. Most of the staff interviews stated that they will get an extra staff, or the Director will come help with ratio. The parents’ interviews show no concern about ratio. Based on LPA’s investigation, there are no Title 22 violations at the facility.

Continue on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 03-CC-20250505233101
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 MOMENTS, INC.
FACILITY NUMBER: 343624251
VISIT DATE: 06/17/2025
NARRATIVE
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Therefore, although the alleged violation may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that it did or did not occur, therefore they are unsubstantiated. There is no deficiency issued today. An exit interview was conducted, notice of site visit, and appeal rights were provided to Licensee Ashley and Jared Winn. Notice of site visit will be posted for 30 consecutive days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 03-CC-20250505233101
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 MOMENTS, INC.
FACILITY NUMBER: 343624251
VISIT DATE: 06/17/2025
NARRATIVE
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 LPA explained to the staff about updating the LIC9227 form with the parents. According to parent, staff gave them an updated forms to fill out two days ago (6/15/2025), which permits C1 to sleep on the stomach.

Based on staff interviews, LPA learned that in the last several months, staffing during breaks and lunch has been an issue and napping infants are left to sleep alone in the nap room. Staff 1 (S1) stated that they conduct 15 minutes checks throughout the day with infants sleeping in the nap room, but S1 does not remain in the nap room. The nap room is a room next to the infant classroom that is connected by a doorway. Based on parent interviews, LPA learned that four out six parents have observed infants sleeping in the nap room without a staff providing supervision.

Based on these interviews, LPA learned there was an absence of supervision, when the infants sleeping in the nap room were left unsupervised. These instances occurred on multiple occasions and at different times throughout the day. LPA also learned that the facility is not following safe sleep practices as C1 is left sleeping on the stomach numerous times. The LIC9227 form doesn’t specify that C1 is able to make the complete roll from back to stomach.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D.

A Title 22 deficiency is being cited on the subsequent pages of this report on LIC9099-D page. Licensee Ashley and Jared Winn acknowledge, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D page with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee. Licensee's signature on this report acknowledges receipt of these rights. This report was reviewed with Licensee Ashley and Jared Winn. A copy of this report, appeal rights, LIC9224, and a notice of site visit was provided to be posted for 30 consecutive days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 03-CC-20250505233101
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 MOMENTS, INC.
FACILITY NUMBER: 343624251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/18/2025
Section Cited
CCR
101429(a)(1)
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Responsibility for Providing Care and Supervision for Infants. (a) In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.
This requirement is not met as evidenced by:
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Licensee will provide extra staffing also supervise the nap room consistenly and they are in the process of hiring new staff. Licensee will email LPA Vang a copy of the signed one-on-one meetings by the POC due date.
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Based on interviews and documentation reviews, multiple parents' and several staff's interviews revealed that the infant's nap room is left upsupervised throughout the day. This is an absence of supervision/visual observation, which posed an immediate health and safety risk to children in care.
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Type A
06/18/2025
Section Cited
CCR
101430(a)(3)(A)
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Infant Care Activities
(3) All infants shall be given the opportunity to sleep without distraction or disturbance from other activities at the center whenever the infant desires.
(A) Staff shall place infants up to 12 month of age on their backs for sleeping.
This requirement is not met as evidenced by:
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Licensee will provide extra staffing also supervise the nap room consistenly to turn the children over, and they are in the process of hiring new staff. Licensee will email LPA Vang a copy of the signed one-on-one meetings by the POC due date.
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Based on interviews and documentation reviews, LPA learned C1 was left sleeping on the stomach multiple times. The communication through the app between a staff and the parent specifying that C1 cannot sleep on the stomach and must be moved to sleep on the back. LPA also observed a photo of C1 sleeping on the stomach. The which posed an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5