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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434413426
Report Date: 09/30/2022
Date Signed: 09/30/2022 11:14:38 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/13/2022 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220713171333
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:67CENSUS: 36DATE:
09/30/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Evangeline PonceTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not qualified

Ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mel Matos conducted an unannounced follow-up complaint investigation and met with Evangeline Ponce, Director. Purpose of today's follow up complaint investigation: deliver investigation findings. LPA toured the Junior Preschool, Preschool, & Pre-K rooms, playground, & reviewed documents during today's investigation.
The investigation of the complaint allegations listed above was conducted by LPA Matos. Based on interviews, record reviews, observations, and evidence gathered during the investigation process, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegation is UNSUBSTANTIATED.

A Notice of Site Visit was provided to Evangeline Ponce, Director, and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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