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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414542
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:31:49 PM

Document Has Been Signed on 04/20/2023 12:31 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 KIDS ACADEMYFACILITY NUMBER:
434414542
ADMINISTRATOR:CLAUDIA ALBORNOZFACILITY TYPE:
850
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 60TOTAL ENROLLED CHILDREN: 50CENSUS: 30DATE:
04/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Manikyavalli RaoTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Mel Matos met with Manikyavalli Rao, director, for an unannounced case management inspection. Purpose of today's inspection: discuss required director paperwork for the director, Manikyavalli Rao. Paperwork for Manikyavalli Rao was submitted to LPA Matos prior to today's inspection.

The following documents are still needed in order for Manikyavalli's file to be complete:

1) Personnel Report (LIC 500) for this license and the infant license (#434414541).
2) Complete college transcripts listing all ECE courses completed, including the infant/toddler course.
3) Copy of Tdap, Mmr, & flu (or flu opt-out) vaccination record.

Manikyavalli agreed to submit the items listed above to LPA by Friday April 28, 2023.

Exit interview conducted and report was reviewed with the Director, Manikyavalli Rao. No deficiencies issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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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