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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408296
Report Date: 12/05/2023
Date Signed: 12/05/2023 02:58:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230912103608
FACILITY NAME:TULIP CHILD CARE LLC/PINOLE MONTESSORIFACILITY NUMBER:
073408296
ADMINISTRATOR:MADDOX, HIDYFACILITY TYPE:
850
ADDRESS:2612 APPIAN WAYTELEPHONE:
(510) 222-9688
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:64CENSUS: 36DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ANGELA LOPESTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Neglect/ Lack of Supervision ~ Staff did not provide adequate supervision to the daycare children.
INVESTIGATION FINDINGS:
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On December 5, 2023 at 1:00 PM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Director Lopes, Angela who is background cleared. LPA advised Director of the nature of the inspection. Current Census today is 36 children which consists of (7) toddler, (29) preschool children. LPA obtained a copy of the children's roster, observations and staff interviews were conducted.

Based on LPA's observations, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,101229(a)(1) is being cited on the attached LIC 9099D.

The attached type A deficiency is cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights and Notice of Site Visit were given and discussed. This report must be available for public review for 3 years.
Substantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 02-CC-20230912103608
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TULIP CHILD CARE LLC/PINOLE MONTESSORI
FACILITY NUMBER: 073408296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2023
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and
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Director will provide training to staff on napping supervision and complete a written statement to LPA by POC date of 12/6/23 by close of business day. Children will have 100% visual supervision at all times.
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101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: A child climbed onto another child's cot during naptime that was advised by another child. During absence of visual supervision which is an immediate risk to the health and safety and personal rights of children in care.
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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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230912103608

FACILITY NAME:TULIP CHILD CARE LLC/PINOLE MONTESSORIFACILITY NUMBER:
073408296
ADMINISTRATOR:MADDOX, HIDYFACILITY TYPE:
850
ADDRESS:2612 APPIAN WAYTELEPHONE:
(510) 222-9688
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:64CENSUS: 36DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ANGELA LOPESTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Reporting Requirements ~ Staff did not properly report an incident involving a daycare child.
INVESTIGATION FINDINGS:
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On December 5, 2023 at 1:00 PM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Director Lopes, Angela who is background cleared. LPA advised Director of the nature of the inspection. Current Census today is 36 children which consists of (7) toddler, (29) preschool children. LPA obtained a copy of the children's roster, observations and staff interviews were conducted.

Based on LPA's observations, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,101212(a)(d)(1)(c) is being cited on the attached LIC 9099D.

The attached type B deficiency is cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights and Notice of Site Visit were given and discussed. This report must be available for public review for 3 years.
Substantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20230912103608
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TULIP CHILD CARE LLC/PINOLE MONTESSORI
FACILITY NUMBER: 073408296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2023
Section Cited
CCR
101212(a)(d)(1)(c)
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101212 Reporting Requirements
(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following:
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Director will discuss with the staff and conduct a meeting about the importance of Reporting Requirements and watch video providing a statement to LPA via email by POC date of December 19, 2023.
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(1) Events reported shall include the following:(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.This requirement was not met as evidenced by: the incident was not reported to licensing within 24 hour timeframe. which is an potential risk to the health and safety of children in care.
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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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4