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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624251
Report Date: 07/09/2026
Date Signed: 07/09/2026 09:48:05 AM

Unsubstantiated


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
06/02/2026 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20260602082849
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: 17DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ashley WinnTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not notify parent of an incident in a timely manner.
Staff did not ensure infant received medical care in a timely manner.
Facility did not provide parents with licensing reports documenting Type A deficiencies.
INVESTIGATION FINDINGS:
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On 7/9/2026, License Program Analysts (LPAs) Pa Dao Vang and Amanda Sutter conducted a complaint investigation and met with Licensee Ashley Winn. It was alleged that the staff did not notify parents of an incident in a timely manner, and the Staff did not ensure infants received medical care in a timely manner, and the facility did not provide the parents with licensing reports documenting Type A deficiencies. There were 4 infants supervised by 3 staff and 13 toddlers children supervised by 4 staff members.

Through the investigation, LPAs made observations, conducted interviews, reviewed files, and reviewed the sign-in and out app. LPAs observed the staff conducting indoor activities with the children. LPAs also observed staff feeding children while holding them. LPAs also verified that parents signed the LIC9224 Acknowledgement of Receipt of Licensing Reports prior to their children’s enrollment 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: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 2
Control Number 03-CC-20260602082849
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: 07/09/2026
NARRATIVE
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Through the staff’s interviews, LPAs learned that on 5/28/2026 S1 slipped on a toy while holding C1 and fell on the floor. LPAs also learned that the S2 witnessed the incident in the classroom and saw C1 on the floor next to S1. C1 was immediately picked up and stopped crying after 3 minutes. According to the staff, C1 did not sustain any bruise or marks. They also stated that C1 was monitored for the rest of the day and there were no concerns. Director stated that she learned about the incident on 5/29/2026 and notified the parent.

Based on observations and interviews, the preponderance of evidence results in unsubstantiating the above allegations. An exit interview, appeal rights and a notice of site visit were provided to Licensee Ashley Winn. A Notice of Site Visit posted. Failure to comply with posting requirements can result in a $100 penalty.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2