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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416277
Report Date: 02/13/2023
Date Signed: 02/13/2023 05:51:24 PM

Document Has Been Signed on 02/13/2023 05:51 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 KIDSFACILITY NUMBER:
434416277
ADMINISTRATOR:NIKKI HUFANAFACILITY TYPE:
830
ADDRESS:10181 FINCH AVENUETELEPHONE:
(669) 377-5774
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 16TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nikki HufanaTIME COMPLETED:
06:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and Jovani Dillon conducted an unannounced Required - 1 Year Inspection. LPAs met with Site Director, Nikki Hufana, and explained to her the purpose of the today's visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 08:00 AM to 6:00 PM. The facility serves children ages one year old to two years. The infant program is licensed in Rooms 4 and 11.

The indoor and outdoor areas were toured. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The staff bathroom is clean, sanitary, and operable. Nikki stated that the facility has third party cleaning service that comes after daycare hours to clean the facility. LPAs observed one sink available for the children in the infant program.

The facility provides morning and afternoon snacks to children. Parents have the option to bring lunch for their children or purchase from "Zesty Kitchen." Foods and beverages were kept protected against contamination and spoilage. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerators, microwave, dishwasher, and a sink with hot and cold running water. Drinking water is available for the children indoor via individual water bottles. LPAs observed trash cans with tight fitting lids for the disposal of solid waste. Fire extinguisher, working smoke and carbon monoxide detectors were observed.

Nikki stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via individual water bottles. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopies. LPAs observed synthetic grass under and around the climbing structure as resilient material. There were no bodies of water observed.

Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
FACILITY NUMBER: 434416277
VISIT DATE: 02/13/2023
NARRATIVE
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LPAs reviewed four (4) children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, Infant Needs and Services Plan, and TB test.

Three (3) staff files were reviewed. Staff records reviewed include Criminal Record Statement (LIC 508), Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. Staff #1, #2, and #3 are missing immunization in measles, pertussis and flu. Staff #1 is missing health screening and TB test. Staff #1 and #2 are missing current Mandated Reporter Training for Child Care Providers. LPAs reminded Site Director that the Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility has Incidental Medical Services (IMS) Plan in the file. Nikki stated that currently, there are no children using medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA Monico discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA informed Site Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Continuation on next page:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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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
FACILITY NUMBER: 434416277
VISIT DATE: 02/13/2023
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, deficiencies were cited on the following pages:

Exit interview conducted and report was reviewed with Site Director, Nikki Hufana.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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Document Has Been Signed on 02/13/2023 05:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 04:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416277

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation and record review, Kristyn Boughton has been working at the facility since 09/28/22 without transferring her fingerprint clearance. This poses an immediate risk to the health, safety or personal rights of children in care.
POC Due Date: 02/14/2023
Plan of Correction
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Site Director submitted Kristyn's Criminal Background Transfer Request (LIC 9182) together with her identification to Guardian and to Licensing during the inspection. Civil penalty of $500 was assessed. Deficiency corrected.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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Document Has Been Signed on 02/13/2023 05:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 04:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416277

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439(h)(4)
Infant Care Center Fixtures, Furniture, Equipment and Supplies
(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the changing table is not within arm's reach of a sink. This poses a potential risk to that health, safety or personal rights of children in care.
POC Due Date: 02/21/2023
Plan of Correction
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Site Director states she will move the diaper changing table next to the sink and the sink will not be used for food preparation but only for staff and children to wash their hands. Site Director states she will submit a written plan and photos to Licensing by 02/21/23.
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Per Site Director, they didn't meet the deadline for their drinking water lead testing but they are scheduled to have their water tested on March 10, 2023. This poses a potential risk to the health, safety or personal rights of children in care in care.
POC Due Date: 02/21/2023
Plan of Correction
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Site Director submitted proof of appointment during the inspection. Site Director states that she will submit a written plan by 02/21/23 to ensure that she will comply with the requirements for lead testing.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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Document Has Been Signed on 02/13/2023 05:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 04:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416277

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, Staff #1, #2, and #3 are missing immunization in measles, pertussis and flu. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states that she will submit proof of immunizations for the three staff by 03/13/23.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review of records, Staff #1 is missing health screening and TB test. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director agreed to submit completed health screening and TB test for staff #1 by 03/13/23.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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Document Has Been Signed on 02/13/2023 05:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 04:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416277

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on record review, Staff #1 and #2 are missing current Mandated Reporter Training for Child Care Providers. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states that she will submit current Mandated Reporter Training certificate for Staff #1 and #2 by 03/13/23.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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