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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414541
Report Date: 08/23/2024
Date Signed: 08/23/2024 11:29:43 AM


Document Has Been Signed on 08/23/2024 11:29 AM - 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:YESENIA VELAZQUEZFACILITY TYPE:
830
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:28CENSUS: 0DATE:
08/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Yesenia VelazquezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Yesenia Velazquez, Director, for an unannounced case management inspection. Yesenia states that the Facility has been closed since yesterday, Thursday August 22, 2024 for staff "in-service". Yesenia states that the Facility will reopen on Monday August 26, 2024.

LPA observed only observed staff on site during today's inspection.

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: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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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