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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416387
Report Date: 02/13/2023
Date Signed: 02/13/2023 05:37:47 PM

Document Has Been Signed on 02/13/2023 05:37 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 KIDSFACILITY NUMBER:
434416387
ADMINISTRATOR:NIKKI HUFANAFACILITY TYPE:
850
ADDRESS:10181 FINCH AVENUETELEPHONE:
(669) 377-5774
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 55TOTAL ENROLLED CHILDREN: 42CENSUS: 37DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Nikki HufanaTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and Jovani Dillon conducted an unannounced Required - 1 Year Inspection. LPAs met with Site Director, Nikki Hufana, and explained to her the purpose of the today's visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 08:00 AM to 6:00 PM. The facility serves children ages 2 years old to entry into kindergarten. LPAs observed that the preschool program is licensed in Rooms 12, 13 and 14, however, LPAs observed Room 11 which is licensed under the infant program is utilized by the children in the preschool program.

The indoor and outdoor areas were toured. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The staff and children's bathrooms are clean, sanitary, and operable. Nikki stated that the facility has third party cleaning service that comes after daycare hours to clean the facility.

The facility provides morning and afternoon snacks to children. Parents have the option to bring lunch for their children or purchase from "Zesty Kitchen." Foods and beverages were kept protected against contamination and spoilage. Foods and beverages were kept protected against contamination and spoilage. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerators, microwave, oven, stove, dishwasher, and a sink with hot and cold running water. Drinking water is available for the children indoor individual water bottles. LPAs observed trash cans with tight fitting lids for the disposal of solid waste. Fire extinguisher, working smoke and carbon monoxide detectors were observed.

Nikki stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via individual water bottles. The playgrounds is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopy, trees, and building overhang. LPAs observed sand under and around the climbing structure and tanbarks under the swings. There were no bodies of water observed.

Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 434416387
VISIT DATE: 02/13/2023
NARRATIVE
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LPAs reviewed nine (9) children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, and TB test.

Seven (7) staff files were reviewed. Staff records reviewed include Criminal Record Statement (LIC 508), Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. Staff #1, #2, #5, #6, and #7 are missing immunizations. Staff #1 and #4 are missing transcripts, and #2 missing Child Development class. Staff #4, #5, and #7 are missing Physician's Report. LPAs reminded Site Director that the Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility has Incidental Medical Services (IMS) Plan in the file. Nikki stated that currently, there are no children using medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Site Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Based on record review, Paramita Chowdhury, has fingerprint clearance, however, her clearance is not transferred to the facility. Paramita has been working at the facility since August 9, 2021. Civil penalty of $500 was assessed.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Continuation on next page:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 434416387
VISIT DATE: 02/13/2023
NARRATIVE
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Site Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

As a result of this inspection, deficiencies were cited on the following pages:

Exit interview conducted and report was reviewed with Site Director, Nikki Hufana.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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Page: 3 of 7
Document Has Been Signed on 02/13/2023 05:37 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 03:21 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Per Site Director, they didn't meet the deadline for their drinking water lead testing but they are scheduled to have their water tested on March 10, 2023. This poses a potential risk to the health, safety or personal rights of children in care in care.
POC Due Date: 02/21/2023
Plan of Correction
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Site Director submitted proof of appointment during the inspection. Site Director states that she will submit a written plan by 02/21/23 to ensure that she will comply with the requirements for lead testing.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, Staff #1, #2, #5, #6, and #7 are missing immunizations in measles, pertussis, and flu. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states that she will submit proof of immunizations for the five staff members by 03/13/23.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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Document Has Been Signed on 02/13/2023 05:37 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 03:21 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, Staff #5 is missing proof of Mandated Reporter Training certificate. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states that she will submit proof of current Mandated Reporter Training for Staff #5 by 03/13/23.
Type B
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Paramita Chowdhury has fingerprint clearance, however, her clearance is not transferred to the facility. Paramita has been working at the facility since August 9, 2021. This poses a potential risk to the health, safety or personal rights risk of children in care.
POC Due Date: 02/14/2023
Plan of Correction
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Site Director submitted completed Criminal Background Transfer Request (LIC 9182) with Paramita's ID to Guardian and to Licensing during the inspection. Civil penalty of $500.00 was assessed.

Deficiency corrected.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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Page: 5 of 7
Document Has Been Signed on 02/13/2023 05:37 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 03:21 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, Staff #4, #5 & #7 are missing the health screening report in their files. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states she will submit proof of completed health screening for the three staff by 03/13/23.
Type B
Section Cited
CCR
101216.1(g)
Teacher Qualifications and Duties
(g) A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, Staff #1 and #4 are working as teachers, however, they are missing their transcripts in their files. Staff #2 is missing proof that she completed Child Development. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 03/13/2023
Plan of Correction
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Site Director states she will submitted copy of transcripts for the staff by 03/13/23.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 02/13/2023 05:37 PM - It Cannot Be Edited


Created By: Marilou Monico On 02/13/2023 at 03:58 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TULIP KIDS
FACILITY NUMBER: 434416387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101162(a)

A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, Room 11 is licensed under the infant program and is being utilitized by the preschool children. This poses a potential risk to the health, safety or personal rights of children in care.
POC Due Date: 02/21/2023
Plan of Correction
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Site Director states she will submit an updated Application for a Child Care Center License (LIC 200A0 for change of capacity and adding Room 11 on the preschool license by 02/21/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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2
3
4
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


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