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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408296
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:38:01 PM

Document Has Been Signed on 06/28/2022 12:38 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
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: 64TOTAL ENROLLED CHILDREN: 35CENSUS: 18DATE:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Susana MoraTIME COMPLETED:
12:45 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
On 06/28/2022 at 9:15 am, Licensing Program Analysts (LPAs) Christina Watts and Morgan Pringle conducted an unannounced case management at Tulip Child Care LLC/ Pinole Montessori. LPAs met with Director Susana Mora and explained the purpose of today's inspection. LPAs returned to facility to follow up on a complaint. At the time of inspection, there were 18 children in care and 35 children enrolled.

While conducting investigations for complaint, it was found that four staff members did not complete the Mandated Reporter training.

LPAs cited a Type B violation for staff not completing mandatory Mandated Reporting Training.

DEFICIENCIES CITED:
1596.8662(4)(b)(1) Failure to renewal Mandated Reporter training.

(See LIC 809-D)
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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 2
Document Has Been Signed on 06/28/2022 12:38 PM - It Cannot Be Edited


Created By: Christina Watts On 06/28/2022 at 11:16 AM
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
, 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: 06/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2022
Section Cited
HSC
1596.8662(4)(b)(1)

1
2
3
4
5
6
7
1596.8662(4)On or before March 30, 2018, ...employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years
1
2
3
4
5
6
7
Director will ensure all staff completes Mandated Reporter Training and will submit proof of completion to LPA Watts by 07/05/2022.
8
9
10
11
12
13
14
...This requirement is not met as evidenced by: 4 staff members missing proof of completion. This poses a potienal health and safety risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2