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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414541
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:56:05 PM


Document Has Been Signed on 07/30/2024 03:56 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:
434414541
ADMINISTRATOR:PUSHPALATHA VENNAFACILITY TYPE:
830
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:28CENSUS: 23DATE:
07/30/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Yesenia VelazquezTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Mel Matos met with Yesenia Velazquez, Director, for an unannounced Plan of Correction (POC) inspection.

LPA toured Classroom 1 with Yesenia Velazquez, Director, and observed 23 infant children with three fully qualified infant teachers and four aides.

The Facility was issued one "Type B" deficiency per Section 101239.1(b)(5) of Title 22 regulations - Napping Equipment - as a result of LPA Matos observing twelve napping mats in Classroom 1 on July 15, 2024 that had exposed foam.

Written Plan of Correction was provided to LPA Matos on July 16, 2024. The Facility obtained 17 cots for the infant children and currently has a mixture of cots and mats for the napping children. Yesenia states that the Facility will conduct biweekly checks to ensure that the napping equipment is safe for the infant children.

Facility has completed the required Plan of Correction and thus the deficiency noted above has been cleared.

Exit interview conducted and report was reviewed with Director, Yesenia Velazquez. 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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