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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414542
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:03:28 PM

Document Has Been Signed on 06/20/2024 04:03 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:TULIP KIDS ACADEMYFACILITY NUMBER:
434414542
ADMINISTRATOR/
DIRECTOR:		PUSHPALATHA VENNAFACILITY TYPE:
850
ADDRESS:1279 LAWRENCE STATIONTELEPHONE:
(669) 255-0540
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 60TOTAL ENROLLED CHILDREN: 49CENSUS: 44DATE:
06/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Yesenia VelazquezTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Mel Matos met with Yesenia Velazquez, director, for an unannounced case management inspection. Yesenia states that she is the director of the Facility since Monday June 17, 2024.

Director paperwork was provided to LPA during today's inspection.

Director states that she is awaiting receipt the following documents and will submit those to LPA Matos once she has received them.

1) Copy of transcript verifying completion of the Supervision/Administrative course (course completed in May 2024).
2) Copy of the Health Screening Report - Facility Personnel (LIC 503) & most recent TB test. Yesenia states that she has an appointment scheduled for July 18, 2024.

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

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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