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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517222
Report Date: 07/22/2025
Date Signed: 07/22/2025 11:47:43 AM

Document Has Been Signed on 07/22/2025 11:47 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SIPOS, GIZELAFACILITY NUMBER:
410517222
ADMINISTRATOR/
DIRECTOR:		SIPOS, GIZELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 321-2162
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
07/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Gizela SiposTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On July 22, 2025 at approximately 8:30AM, Licensing Program Analyst (LPA) Katie Krenn arrived for an unannounced annual visit at the facility. LPA met with Licensee, Gizela Sipos and explained the purpose of the visit. Present during the visit in addition to the Licensee were two helpers, two infants, and six preschool children. Facility is operating within capacity limits on this day. All adults living and working in the home are fingerprint cleared and associated with the facility.

Licensees owns home, which is a 2 bedroom, 2 bathroom, single level house.
The hours of operation are Monday - Friday from 7:30AM - 5:30PM.
Daycare areas: Playroom/converted Garage, Bathroom #1, Kitchen (eating only), Dining area (napping only), Backyard, and Back Porch.
Off Limit areas: Living Room, Bedroom #1, Bedroom #2, Bathroom #2, Side and Front yards. All off-limit areas are properly barricaded.
There are no pools, and bodies of water in the premises.

LPA observed that all required documents, such as the facility license, the Notification of Parental Rights, Car Seat Laws, Disaster Plan, Facility Sketch, and Business License, were displayed and visible to the public. LPA printed a copy of the and the Earthquake Preparedness Checklist and observed licensee post it during the visit. An app is used to sign children in and out. LPA observed that the children present were signed in.

The facility is currently providing breakfast, lunch, and snacks for children in care. Per licensee none of the children currently in care have any allergies or require the facility to administer any medications.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SIPOS, GIZELA
FACILITY NUMBER: 410517222
VISIT DATE: 07/22/2025
NARRATIVE
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LPA toured day care areas of home with Licensee to inspect for health and safety hazards. LPA observed home to be clean and in good repair with proper temperature and ventilation. There were a variety of age appropriate toys, learning materials, craft supplies, and equipment in the home which were in good condition. Furniture is age-appropriate and free of rough or sharp edges. Licensee has a pet turtles. All cleaning supplies, poisons and other chemicals were stored inaccessible to children.

LPA observed three fully charged fire extinguishers and observed that they had been check by the fire department. LPA observed smoke alarm and carbon monoxide alarm, LPA tested them and found them to be working properly. Licensee maintains a working telephone on site. Phone number listed for Licensee is current. Per Licensee, there are no weapons or firearms in the home.

LPA reviewed four children’s records and found all the necessary documentation. LPA also reviewed licensee and assistant records. Licensee and an additional staff member have current Pediatric CPR & First Aid Certificate. Licensee and staff have current mandated reporter training. LPA observed the Emergency drill log; the last documented emergency drill was conducted in May 2025. LPA observed that both fire and earthquake drills were documented at least ever six months.

LPA observed there to be mats for the children to nap. Bedding is provided from home and wash onsite at least once a week and more frequently if needed. LPA observed that there were 15 minute sleep log records for both infants.

LPA observed that there were sufficient highchairs available for children in care, per licensee used only for feeding. The home was clean and free of debris.

LPA observed the outdoor play area had a fence surrounding it that is at least 5 feet high. There was a covered area with age-appropriate toys and furniture. LPA observed that child proof gates were being used to keep the children off the stairs. In the uncovered outdoor play area, tan bark was used under slides, swings, and climbing equipment. In the outdoor play area LPA observed that the age-appropriate toys and play furniture in good repair.

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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SIPOS, GIZELA
FACILITY NUMBER: 410517222
VISIT DATE: 07/22/2025
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To improve the quality and value of the inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Gizela Sipos.
NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
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