434413427-11-9-2020-07-CC-DSTN-BV8PQC-20201110103053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434413427
Report Date: 11/09/2020
Date Signed: 11/09/2020 09:38:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2020 and conducted by Evaluator Melvin S Matos

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20200828155735

FACILITY NAME:	TULIP KIDS ACADEMY		FACILITY NUMBER:	434413427
ADMINISTRATOR:	EVANGELINE PONCE		FACILITY TYPE:	830
ADDRESS:	1159 WILLOW AVENUE		TELEPHONE:	(408) 340-7993
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 2	DATE:	11/09/2020
		ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Evangeline Ponce		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Child received unexplained injury while in care
Child was left in soiled clothing for an extended period of time
Facility staff is not feeding child
Facility staff is not storing food in a safe manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mel Matos conducted an announced tele-investigation via FaceTime (#408-504-2380) with Evangeline Ponce, director, today. Purpose of today's tele-investigation: deliver investigation findings.
The investigation of the four complaint allegations listed in this complaint was conducted by LPA Mel Matos. Based on the available evidence and interviews completed for the complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED.
LPA Matos to forward a copy of today’s report to Evangeline Ponce, director, via email (evangeline@tulipkidsinc.com). LPA requested that Evangeline respond to the “read receipt” confirmation/send confirmation of receipt email to LPA within 24 hours confirming receipt of today’s report. A Notice of Site Visit will also be forwarded to Evangeline via email and will be required to be posted near the entrance to the day care for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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