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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 04/20/2023
Date Signed: 04/20/2023 03:08:46 PM


Document Has Been Signed on 04/20/2023 03:08 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 ACADEMYFACILITY NUMBER:
434413427
ADMINISTRATOR:EVANGELINE PONCEFACILITY TYPE:
830
ADDRESS:1159 WILLOW AVENUETELEPHONE:
(408) 340-7993
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 11DATE:
04/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Evangeline PonceTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, director, for an unannounced. Purpose of today's inspection: discuss age ranges of the infant license. LPA toured Room 4 and observed 11 napping infant children with two fully qualified teachers.

Evangeline inquired about changing the age to 9 months to 2 years of age. LPA advised Evangeline that any children under 1 year of age will require a crib in the classroom. LPA also advised that any space within the classroom dedicated for crib space will not count as usable classroom space and therefore the capacity of the infant license might need to be reduced.

Evangeline states that she understands LPA's explanation and will forward a copy of today's report to Deepti Mohta, Licensee representative.

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 StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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