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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 08/22/2024
Date Signed: 08/22/2024 04:24:07 PM


Document Has Been Signed on 08/22/2024 04:24 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: 8DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Evangeline PonceTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, Director, 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 the playground area during today's inspection and observed the following:

LPA observed eight infant children with two qualified infant teachers and two aides in the playground area during today's inspection.

Evangeline Ponce, director, states that there are 13 infants enrolled in Room 4 (infant room) at this time. Evangeline understands that the Facility cannot have more than 14 infants in Room 4 (infant room) at any time.

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: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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