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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416979
Report Date: 09/14/2022
Date Signed: 09/14/2022 03:39:34 PM

Document Has Been Signed on 09/14/2022 03:39 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:
434416979
ADMINISTRATOR:NEERU SHARMAFACILITY TYPE:
830
ADDRESS:6097 COTTLE ROADTELEPHONE:
(408) 483-8941
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 29TOTAL ENROLLED CHILDREN: 22CENSUS: 13DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Neeru SharmaTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janette Cruz, conducted an unannounced case management visit and met with Neeru Sharma, Infant Director. LPA toured the two infant classrooms and reviewed children and staff files. While conducting inspection on the infant classrooms, LPA observed that one adult identified as S7, who were taking care of infants did not have criminal record clearance and still showing a pending "In Process" clearance status on the "Guardian."

Director did not have any proof to show that adult S7 had her fingerprint live scan done. Director immediately removed S7 from the infant classroom and stated that S7 will no longer continue employment at the facility.

A deficiency was cited with civil penalty, appeal rights also given. See (809-D). Exit interview was conducted with Neeru Sharma, Infant Director. .

A Notice of Site Visit was issued and must be posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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 09/14/2022 03:39 PM - It Cannot Be Edited


Created By: Janette Cruz On 09/14/2022 at 02:10 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 ACADEMY
FACILITY NUMBER: 434416979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2022
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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Civil penalty of $500 assessed today (see LIC 421BG). The Licensee will submit a written statement to the Department by POC due date, indicating understanding that all adult(s) must obtain the required criminal record and child abuse index clearances prior to working or volunteering in licensed facility.
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Based on observation, record reviews and interviews, Licensee did not comply with section cited above. LPA observed adult identified as S7 who were providing care to infants enrolled did not obtain criminal record and child abuse index clearances prior to working in the facility. This poses a potential threat to health and safety of children in care.
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022


LIC809 (FAS) - (06/04)
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