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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624252
Report Date: 10/11/2024
Date Signed: 10/11/2024 02:43:23 PM

Document Has Been Signed on 10/11/2024 02:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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:
343624252
ADMINISTRATOR/
DIRECTOR:		SIMMONS, TIFFANYFACILITY TYPE:
850
ADDRESS:750 N STREETTELEPHONE:
(916) 626-2739
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 23DATE:
10/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Simmons, Tiffany TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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At 9:00 a.m. on Friday, October 11th, 2024, Licensing Program Analyst (LPA) Pa Dao Vang met with Director, Tiffany Simmons, for the purpose of an unannounced, annual required inspection. LPA observed a census of 23 children supervised by 4 staff. Facility hours of operation are from 7:00 a.m. - 6:00 p.m., Mondays thru Fridays. Center provides breakfast, and p.m. snack for the children. Parents provide lunch for the children daily. The facility does not offer transportation services.

Director 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.

LPA conducted a health and safety inspection of the classrooms, restrooms, and food service area. The facility is currently using classrooms Toddler 2 and Preschool 2 rooms as storage. Both rooms are licensed for children. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Earthquake Preparedness, Child Passenger Restraint Poster, Parent’s Notification, LIC613A Person Rights, Daily Activity Schedule, and menus. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition. LPA observed a drinking fountain taped off in the classroom. Drinking water is accessible via water bottles. The water bottles are transitioned with children to different environments.

LPA observed trash bins with tight fitted lids. Toileting facilities are in safe, sanitary condition. The floors appeared to be clean throughout the facility. Director stated that there is no smoking, no firearms nor poisons on the premises. LPAs observed the facility’s sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 06/4/2024.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 343624252
VISIT DATE: 10/11/2024
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Facility provides Incidental Medical Services. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 conducted a health and safety inspection of the outdoor space. The play structure is free of loose or sharp parts with proper cushioning under it. Outdoor shade was provided by canopy, and buildings.



LPA reviewed staff and children's records. LPA observed current employee rights, and documentation of the educational background, training, immunization, and/or experience. There is at least 1 staff with current CRP/First Aid certification in the facility.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Director stated the building was built in 2022.



Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Continue report on LIC809-C...
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 343624252
VISIT DATE: 10/11/2024
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No deficiency is being cited today based on LPA’s observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with Director Tiffany Simmons. An exit interview was conducted, a copy of this report, appeal rights, and a notice of site visit were also provided to Director. Notice of site visit shall remain posted for a period of 30 consecutive days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
LIC809 (FAS) - (06/04)
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