434413427-9-20-2022-07-CC-MSMS-CJFV5T-20220920160827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 09/20/2022
Date Signed: 09/20/2022 04:08:33 PM

Document Has Been Signed on 09/20/2022 04:08 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
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: 13	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Evangeline Ponce		TIME COMPLETED:	04:15 PM

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. The Facility is licensed for 14 infant children (ages 12-24 months) in Classroom #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. Days and hours of operation are Monday through Friday 8:00 AM to 6:00 PM. LPA reviewed ten children's and five staff files (1 director, 3 teachers, and 1 aide) during today's inspection. Each child's file reviewed contains the required forms, including Needs & Services Plans. All staff files reviewed contain the required forms, including transcripts/verification of experience/immunization records, & Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on July 28, 2022. All staff have current CPR and 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). LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 25 napping children with three teachers in the Facility during today's inspection. Evangeline understands the conditions, limitations, and capacity specifications of the Facility license. Evangeline understands that children shall be visually supervised at all times and never left unattended. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has adequate ventilation, including central air conditioning/heating. Evangeline states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Evangeline understands that the Facility must be kept free of flies and other insects & rodents. 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 think and in good condition. Napping equipment is appropriate.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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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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: 09/20/2022

NARRATIVE

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Drinking water is readily available for the children in Room 4 and in the outdoor playground area via water coolers and sippie cups. Staff and children's 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 Facility has functioning carbon monoxide detectors in the Facility.

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. The Facility provides morning/afternoon snacks and lunches for the children. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Evangeline states that there are no poisons in the Facility. LPA observed a complete First Aid kit in the Facility. Evangeline states that the Facility does not administer any medications at this time. Evangeline understands that smoking is not allowed on the Facility premises.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

The playground area utilized by children is surrounded by appropriate 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 playground area. Shade is provided by building overhang and sun sails. LPA did not observe any bodies of water. Evangeline states that the Facility does not provide transportation.

Evangeline 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with the Director, Evangeline Ponce. No deficiencies issued during today's inspection. A notice of site visit was given 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: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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