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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 05/07/2019
Date Signed: 05/07/2019 09:15:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:TULIP KIDS ACADEMYFACILITY NUMBER:
434413427
ADMINISTRATOR:EVANGELINE PONCEFACILITY TYPE:
830
ADDRESS:1159 WILLOW AVENUETELEPHONE:
(408) 340-7993
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 2DATE:
05/07/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Evangeline PonceTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, director, for an unannounced case management inspection.

A previous follow up case management inspection was conducted on March 28, 2019 & April 19, 2019 (noted on the preschool license: #434413426) to address the Facility request to add the Activity Room to the Facility license for rainy/hot day activities and special events.

One of the columns near the exit door leading to the playground had 1) chipping/peeling paint and the 2) baseboard in the vicinity of the column had water stains. LPA previously advised Evangeline that both items listed above needed to be replaced/repaired before LPA can approve adding the Activity Room to the license.

LPA toured the Activity Room during today's inspection and notes that the repairs for the two items noted above have been completed and that the room is ready for use.

LPA advised Evangeline that the Activity Room will be added to the Facility license as of today, May 7, 2019, and that a revised license will be sent to the Facility within 1-2 weeks.

No deficiencies issued during today's inspection.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
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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