343624252-5-19-2022-03-CC-ATIY-CEKQ8A-20220519115626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624252
Report Date: 05/19/2022
Date Signed: 05/19/2022 11:56:42 AM

Document Has Been Signed on 05/19/2022 11:56 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:	343624252
ADMINISTRATOR:	TEENEY, ASHLEY		FACILITY TYPE:	850
ADDRESS:	750 N STREET		TELEPHONE:	(707) 583-3333
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 72	CENSUS: 0	DATE:	05/19/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ashley Teeney and Jared 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 Applicants Ashley Teeney and Jarred Winn for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 72 preschool children from age two to five years old. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 05/18/2022. 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. INDOOR ACTIVITY SPACE: There are two classrooms: Preschool Room 1 (ages 2-5) and Preschool Room 2 (age 2-5). LPA did not observe a sufficient amount of age-appropriate equipment, toys, tables, chairs, and cubbies. Applicant stated that these items are currently in storage and will be placed in the facility today and tomorrow. There is a kitchen to support the food service equipped with a refrigerator, pantry and dishwasher. There are washer and dryers equipped on the premises, in the infant and toddler rooms. There is no first aid kit on the premises; Applicant stated that the first aid kit is too in the storage. Applicant stated that cleaning disinfectants will be stored in the classrooms in a higher cabinet. Applicant stated medications will be stored in the classrooms in a lock box. Applicant stated there are no firearms on the premises. Applicant stated there will be pitchers and sippy cups available in the classrooms. LPA observed 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. (Report continues 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: 343624252
	VISIT DATE: 05/19/2022

NARRATIVE

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LPA measured all active, indoor classroom spaces. The total classroom space contains a total of 2702 square feet, which will accommodate the requested capacity of 72 preschool children. The facility has a total of 25 sinks and 11 toilets available for children, which 5 toilets and 10 sinks are designated for preschool children. There is a separate private restroom for the staff. Children who become ill during the day will be isolated in the (wellness room) office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is an outdoor area for preschool that is physically separate from the infant outdoor space. The outdoor play area is surrounded by a fence that is at least four feet tall. There is one anchored play structure on the playground. LPA did not observe a safety label. Applicant was encouraged to obtain a safety and to follow safety label and manufacturer guidelines, if available. LPA did not observe sufficient amount of age-appropriate equipment and toys; Applicant stated these items are in storage. There are shaded areas supplied by a sail canopy and trees. AS observed artificial grass and rubber material used as cushion under climbing structure.

LPA measured the outdoor activity space. The outdoor play area contains a total of 14,765 square feet, which will accommodate Applicant's request for 72 preschool children. The facility will provide drinking water via water pitcher, and have children bring sippy cups. Applicant stated the facility will also provide sippy cups for those children who do not have one.

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 continues 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: 343624252
	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 continues...

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: 343624252
	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

12. Outdoor play equipment

13. First aid kit

14. Trash bins with tight fitted lids

15. 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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