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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 07/30/2024
Date Signed: 07/30/2024 02:27:41 PM


Document Has Been Signed on 07/30/2024 02:27 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: 11DATE:
07/30/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Evangeline PonceTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, Director, for an unannounced Plan of Correction (POC) 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 11 napping infant children with one qualified infant teacher and one aide.

The Facility was issued one "Type A" deficiency per Section 101161(a) of Title 22 regulations - Limitations on Capacity - as a result of LPA Matos having observed 15 napping infant children with one qualified infant teacher and one aide in Room 4 at 1:50 PM on Friday July 26, 2024. Maximum capacity for Room 4 cannot exceed 14 infants.

Director states that the Facility moved three infants to another site, located at 1279 Lawrence Station, Sunnyvale, CA 94089 (Facility #: 434414541).

The Facility was also issued one "Type B" deficiency per Section 101170(e)(2) of Title 22 regulations- Criminal Record Clearance - as a result of the Facility allowing one adult staff to start working in Room 4 on Mon 07/22/24 before criminal record & child abuse index clearances were transferred to this license. The criminal record & child abuse index clearances for the one adult staff were not transferred to this license on Friday July 26, 2024.

Written Plan of Correction was provided to LPA Matos on Monday July 29, 2024. Facility has completed the required Plan of Correction and thus the two deficiencies noted above have been cleared.

Exit interview conducted and report was reviewed with 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: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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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