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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413427
Report Date: 10/21/2024
Date Signed: 10/21/2024 03:36:17 PM


Document Has Been Signed on 10/21/2024 03:36 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: 3DATE:
10/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jayshri PatilTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Jayshri Patil, fully qualified infant teacher, 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. Evangeline Ponce, director, was not present during today's inspection.

LPA toured Room 4 during today's inspection and observed the following:

LPA observed three infant children with one qualified infant teacher and one aide in Room 4 during today's inspection. Jayshri states that the Facility only has four infants enrolled at this time.

Jayshri Patil, fully qualified infant teacher, states that there are four infants enrolled in Room 4 at this time.

Exit interview conducted and report was reviewed with fully qualified infant teacher, Jayshri Patil. 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: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024
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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