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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413426
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:07:32 AM

Document Has Been Signed on 11/21/2022 11:07 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: 48CENSUS: 40DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Evangeline PonceTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mel Matos met with Evangeline Ponce, director, for an unannounced case management inspection.

LPA toured three preschool classrooms and observed the following staff & preschool children during today's inspection:

Room 1 - Jr Preschool Room: two fully qualified teachers, one aide with no ECE units, with 18 preschool children.

Room 2 - Pre-K Room: one fully qualified teacher with 10 preschool children.

Room 3 - Preschool Room: two fully qualified teachers with 12 preschool children.

The Facility was operating within the required ratios/capacity during today's inspection.

Evangeline states that the Facility will be closed for the Christmas/New Year holiday from Monday December 19, 2022 to Monday January 2, 2023. Evangeline states that the Facility will reopen on Tuesday January 3, 2023.

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

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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