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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414542
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:43:09 AM

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 KIDS ACADEMYFACILITY NUMBER:
434414542
ADMINISTRATOR:CLAUDIA ALBORNOZFACILITY TYPE:
850
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY:60CENSUS: 37DATE:
12/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mai NguyenTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mel Matos met with Mai Nguyen, assistant director, for unannounced case management inspection. LPA toured the Facility both indoor and outdoor areas of the Facility during today's inspection.

LPA observed 16 preschool children with two teachers in Classroom #2 and 21 preschool children with two teachers in Classroom #3 during today's inspection.

LPA observed all staff and preschool children wearing face coverings during today's inspection. Mai states that there is sufficient inventory of face coverings for the preschool children and staff at the Facility.

LPA reminded Mai that all children two years and older and all adults must wear face coverings, except during eating and napping, per the guidance from the Santa Clara County Public Health Department and California Department of Public Health. Mai understands that the Facility must adhere to the guidance issued by the public health department regarding face coverings at all times.

Exit interview conducted and report was reviewed with the assistant director, Mai Nguyen. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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