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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413426
Report Date: 11/15/2023
Date Signed: 11/15/2023 10:26:15 AM

Document Has Been Signed on 11/15/2023 10:26 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: 50CENSUS: 37DATE:
11/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Evangeline PonceTIME COMPLETED:
10:30 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 met with Evangeline Ponce, director, for an unannounced Plan of Correction (POC) inspection. LPA toured the Facility during today's inspection with Evangeline Ponce, director.

The Facility was issued one "Type B" deficiency under section 101239.1(a) of Title 22 regulations during LPA's previous inspection on November 3, 2023. LPA observed nine napping mats in Room 1 (Jr Preschool Room) that had exposed foam during LPA's previous inspection on November 3, 2023. The mats with exposed foam presented a potential risk to the health, safety, or personal rights of children in care. The napping mats were removed from Room 1 (Jr Preschool Room) during by Evangeline Ponce, director, during the inspection of November 3, 2023.

Evangeline states that the Facility ordered 33 cots and also obtained extra mats for the younger preschool children. LPA observed sufficient mats and cots in the Facility during today's inspection. Evangeline states that the Facility is transitioning from mats to cots for the older preschool children.

The Facility also submitted a written Plan of Correction listing the Facility protocol of inspecting all mats at least once per month to ensure that the napping mats are maintained in a safe condition at all times.

LPA concludes that the Facility has completed the Plan of Correction and the Type B deficiency issued on November 3, 2023 is thus cleared as of today's inspection.

Exit interview conducted and report was reviewed with Director, Evangeline Ponce. No deficiencies issued during today's inspection. Notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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