<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414541
Report Date: 12/01/2022
Date Signed: 12/01/2022 04:18:35 PM


Document Has Been Signed on 12/01/2022 04:18 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:
434414541
ADMINISTRATOR:CLAUDIA ALBORNOZFACILITY TYPE:
830
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:28CENSUS: 15DATE:
12/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Manikyavalli RaoTIME COMPLETED:
04:30 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 Manikyavalli Rao, director, for an unannounced case management inspection. Purpose of today's inspection: discuss required director paperwork for the new director, Manikyavalli Rao. Paperwork for Manikyavalli Rao was submitted to LPA Matos prior to today's inspection.

The following documents are still needed in order for Manikyavalli's file to be complete:

1) Designation of Facility Responsibility (LIC 308) designating Manikyavalli Rao as director for this license and the preschool license #434414541.
2) Personnel Report (LIC 500) for this license and the preschool license #434414541.
3) Emergency Disaster Plan (LIC 610) for this license and the preschool license #434414541.
4) Complete college transcript of all ECE courses completed.
5) Copy of Tdap, Mmr, & flu (or flu opt-out) vaccination record.
6) Proof of enrollment in the Preventative Health/Safety course (8 hour course).

LPA advised Manikyavalli that the Facility file will be updated to reflect her as the Facility director once all of the above items have been submitted.

Exit interview conducted and report was reviewed with the Director, Manikyavalli Rao. 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: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1