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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 07/26/2024
Date Signed: 07/26/2024 04:15:09 PM


Document Has Been Signed on 07/26/2024 04:15 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
SAN JOSE CC RO, 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: 15DATE:
07/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Evangeline Ponce & Deepti MohtaTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, director, and Deepti Mohta, Licensee representative, for an unannounced case management inspection. The Facility is licensed for 14 children (ages 12-24 months) in Room #4. The Facility also has a preschool program (#434413426) on the same premises and that program is licensed in Rooms 1, 2, & 3.

LPA toured Room 4 with Evangeline Ponce, director, and observed 15 napping infant children with one qualified infant teacher and one aide. LPA notes that the infant license capacity is 14 children and thus the Facility was operating beyond that capacity limitation of the license.

LPA spoke with S1 from Room 4 who confirmed that she started working in Room 4 as of Monday July 22, 2024. The criminal and child abuse clearances for S1 were not transferred to this license until today, Friday July 26, 2024.

One "Type A" and one "Type B" deficiency is being cited on the attached LIC 9099-D. Civil penalties of $400 (allowing staff (S1) to work at the Facility prior to transferring criminal and child abuse clearances for S1 to the Facility license ) - LIC 421BG - were assessed during today's case management inspection. Exit interview conducted and report was reviewed with Director, Evangeline Ponce, and Licensee representative, Deepti Mohta. Appeal rights was also provided to Evangeline and Deepti prior to conclusion of today's inspection.

A notice of site visit was issued and posted near the facility entrance along with the Type "A" deficiency and both notices must remain posted for 30 consecutive days. The Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
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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Document Has Been Signed on 07/26/2024 04:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: TULIP KIDS ACADEMY
FACILITY NUMBER: 434413427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2024
Section Cited
CCR
101161(a)

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Limitations on Capacity: A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement was not met as evidenced by:
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Evangeline Ponce, director, agreed to drop one infant child by Monday July 29, 2024 to ensure that the Facility is operating within its licensed capacity. Director agreed to submit a written plan outlining procedure(s) to be implemented to ensure the Facility is operating within the licensed capacity at all times.
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LPA Matos observed 15 napping infant children with one qualified infant teacher and one aide in Room 4 at 1:50 PM today. This presents an immediate risk to the health, safety, or personal rights of children in care.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months.

A copy of the signed LIC 9224 must be kept in each child's file.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 07/26/2024 04:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: TULIP KIDS ACADEMY
FACILITY NUMBER: 434413427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2024
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f)
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Evangeline Ponce, director, agreed to submit a written Plan of Correction outlining procedure(s) to be implemented to ensure all Facility staff have criminal record & child abuse index clearances associated
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This requirement was not met as evidenced by: S1 started working in Room 4 on Mon 07/22/24, but criminal record & child abuse index clearances were not transferred to this license until Fri 07/26/24. This presents a potential risk to the health, safety, or personal rights of children in care.
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to the Facility prior to working at the Facility.

$400 immediate civil penalties assessed today.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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