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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624252
Report Date: 08/22/2022
Date Signed: 08/22/2022 11:02:41 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:
343624252
ADMINISTRATOR:TEENEY, ASHLEYFACILITY TYPE:
850
ADDRESS:750 N STREETTELEPHONE:
(707) 583-3333
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 29DATE:
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 29 preschool children, supervised by 5 staff members.

Program was pending licensure due to insufficient amount of equipment, cots, cubbies, chairs and tables and pending documents. During todays inspection, LPA observed enough cots, cubbies, chairs and tables for the requested capacity amount of 72. Since LPAs previous visit, LPA has received all requested documents.

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

Effective 8/22/2022, the facility is licensed for 72 preschool children, ages 2 to 5 years old.
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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