434413427-8-20-2021-07-CC-MSMS-C63P4H-20210820105910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 08/20/2021
Date Signed: 08/20/2021 10:59:17 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 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: 0	DATE:	08/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Evangeline Ponce		TIME COMPLETED:	11:00 AM

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), Mel Matos, met with Evangeline Ponce, director, for an unannounced 1 year required inspection. LPA toured the Facility both indoor and outdoor areas of the Facility during today's inspection. LPA notes that the infant program is licensed in Room 4. The Facility also has a preschool program (#434413426) on site and that program is licensed in Rooms 1, 2, & 3. The Facility also uses the Activity Room for rainy/hot day activities and special events. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. The Facility has two active waivers on file (shared playground and electronic sign in and out) and is in compliance with the conditions of both waivers. A review of staff records on August 20, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Evangeline of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. LPA reviewed ten children's and four staff (2 teachers & 2 aides) files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and Needs & Services Plans. Needs & Services Plans also include individual feeding plans for each child. LPA reminded Evangeline that all Needs & Services Plan must be updated quarterly or sooner if necessary. The two teacher files reviewed contain the required transcripts/verification of experience. All infant staff have completed the required Mandated Reporter training for Child Care Workers. All infant teachers have either completed the required infant/toddler course(s). At least one staff has valid CPR & First Aid certifications on file. Evangeline understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/20/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS ACADEMY	FACILITY NUMBER: 434413427
	VISIT DATE: 08/20/2021

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/20/2021):

No infant children were present during today's inspection since the Facility was closed due to teacher in-service. Evangeline understands the conditions, limitations, and capacity specifications of the Facility license. Evangeline understands that infants shall be visually supervised at all times and never left unattended.

LPA observed that Room 4 is clean and safe for all children and staff. Drinking water is readily available for the children in the infant room and in the outdoor playground area via sippie cups and pitchers/disposable cups. LPA observed solid waste container with tight-fitting lids in the infant room. The staff bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Evangeline states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Any medications at the Facility are stored in the director's office.

LPA observed that all furniture and equipment is in good condition and safe for the children. The infant changing table has raised sides that are at least 3 inches in height. The infant changing table has a vinyl changing pad that is at least 1 inch thick. Napping equipment (mats) is appropriate. LPA observed all furniture and equipment is in good condition and safe for the children. Sufficient shade is provided by a canopy and building overhang. The playground area utilized by children is surrounded by fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials (rubber surfacing) in the outdoor playground area. LPA did not observe any bodies of water during today's inspection.

LPA conducted an exit interview with Evangeline and advised her that no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC809 (FAS) - (06/04)

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