<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413426
Report Date: 08/20/2021
Date Signed: 08/20/2021 11:01:29 AM

Document Has Been Signed on 08/20/2021 11:01 AM - 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:
434413426
ADMINISTRATOR:EVANGELINE PONCEFACILITY TYPE:
850
ADDRESS:1159 WILLOW AVENUETELEPHONE:
(408) 340-7993
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 67TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Evangeline PonceTIME COMPLETED:
09:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Mel Matos conducted an unannounced case management inspection. LPA met with Evangeline Ponce, director, and explained the nature of today's inspection to her. No children were present during today's inspection since the Facility was closed due to in-service day. Evangeline states that the Facility is considering dropping one preschool room and adding that room to the existing infant license (#434413427).

LPA advised Evangeline that the Facility will have to submit the following to request a reduction of capacity for the preschool license and increase of capacity for the infant license:

1) Application for a Child Care Center License (LIC 200A) - one for each license.
2) $25 payment - one for each license.
3) Updated Facility sketch (indoor & outdoor) - one for each license with all rooms labeled.
4) Updated Emergency Disaster Plan (LIC 610) - one for each license.
5) Personnel Report (LIC 500) - one for each license.
6) Waiver request for shared use of playground - one for each license.
7) Paperwork for infant assistant director since the Facility will be requesting a capacity of 31 infants.
LPA advised Evangeline that a fire clearance approval from the Sunnyvale Department of Public Safety will be requested upon receipt of the above noted items. A follow up inspection will be required once a fire clearance approval has been received.

No deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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 1