434414541-7-10-2019-07-CC-MSMS-BDXV3C-20190710160431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414541
Report Date: 07/10/2019
Date Signed: 07/10/2019 04:04:59 PM

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 ACADEMY		FACILITY NUMBER:	434414541
ADMINISTRATOR:	CLAUDIA ALBORNOZ		FACILITY TYPE:	830
ADDRESS:	1279 LAWRENCE STATION		TELEPHONE:	(669) 255-0540
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	28	CENSUS: 21	DATE:	07/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Claudia Albornoz		TIME COMPLETED:	04:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Mel Matos, met with Claudia Albornoz, director, for an unannounced annual/random inspection. LPA notes that the Facility is licensed for 28 infant children (ages 12-24 months) in Classroom #1. The Facility also has a preschool program (#434414542) on site and that program is licensed in Classrooms #2 & #3. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. The Facility has one active waiver on file (shared playground use) and is in compliance with the conditions of the waiver. A review of staff records on July 09, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Claudia of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. LPA reviewed ten children's and five staff (3 teachers & 2 aides) files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and Needs & Services Plans. The Needs & Services Plans include individual feeding plans for each child. LPA observed two Needs & Services Plans that have not been updated since March 2019. All teacher files reviewed contain the required transcripts/verification of experience. All infant teachers are fully qualified and have completed the required infant/toddler course. Claudia and two staff have current CPR and First Aid certifications on file. Claudia understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/10/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ACADEMY	FACILITY NUMBER: 434414541
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2019 Section Cited CCR 101419.3(a)	1 2 3 4 5 6 7	Modifications to Infant Needs and Services Plan: The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement was not met as evidenced by	1 2 3 4 5 6 7	A written Plan of Correction detailing the Facility protocol for ensuring that all Infant Needs and Services Plans are updated at least once every quarter, or as often as necessary will need to be
	8 9 10 11 12 13 14	The Needs & Services Plans of two infant children have not been updated since March 2019. This presents a potential risk to the health/safety of children in care.	8 9 10 11 12 13 14	submitted to LPA Matos by Friday August 26, 2019.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ACADEMY	FACILITY NUMBER: 434414541
	VISIT DATE: 07/10/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/10/2019):

LPA observed that the teacher/child ratio was in compliance during today's inspection. Claudia understands the conditions, limitations, and capacity specifications of the Facility license. Claudia understands that infants shall be visually supervised at all times and never left unattended. LPA observed two fully qualified teachers and two aides with 21 napping infant children during today's inspection.

LPA observed that all rooms are clean and safe for all children and staff. Claudia states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in Classroom #1 and in the outdoor playground area via drinking fountains, sippie cups, & pitchers/disposable cups. LPA observed solid waste containers with tight-fitting lids in Classroom #1. Staff bathrooms are clean, sanitary, and operable. The separate staff bathroom can be used by an isolated child if needed. Claudia states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Claudia states that there are no children on medication at this time.

LPA observed all furniture and equipment is in good condition and safe for the children. The infant changing table has raised sides that are at least 3 inches in height. The infant changing table has a vinyl changing pad that is at least 1 inch think and in good condition. Napping equipment is appropriate.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient material in the outdoor playground area. LPA did not observe any bodies of water.

The following "Type B" deficiency is noted on the attached page (809-D). Appeal rights provided to Claudia prior to the conclusion of today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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