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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517222
Report Date: 11/06/2019
Date Signed: 11/06/2019 10:46:04 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SIPOS, GIZELA & RENKEL, VANESSAFACILITY NUMBER:
410517222
ADMINISTRATOR:SIPOS, G. & RENKEL, V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 321-2162
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:12CENSUS: 10DATE:
11/06/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Licensee, Gizela SiposTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Cindy Interiano, met with Licensee, Gizela Sipos. Purpose of the inspection was explained and was for a Required - 3 year inspection. Present in the facility is Licensee and 2 Helpers caring for 6 children (3 infants and 3 PreK) in the home and Co-Licensee, Vanessa Renkel and a Helper caring for 4 PreK children at an offsite activity. Licensees have signed Field trip forms on file. Vehicle is equipped with age appropriate car seats. Licensees owns home, which is a 2 bedroom, 2 bathroom, single level house. Facility was inspected and Daycare areas are: Playroom/converted Garage, Bathroom #1, Kitchen (eating only), Dining area (napping only), Backyard, and back porch. Off Limit areas are: Living Room, Bedroom #1, Bedroom #2, Bathroom #2, and Front yard. All off limit areas are properly barricaded. LPA observed the following: Daycare area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Home has sufficient lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There is no fireplace in the daycare area. There are no bodies of water in the Home. There are no poisons, detergents, or cleaning products accessible to daycare children. Licensee states there are no guns or weapons of any kind in the home. Licensee’s CPR expires in 07/2020 and Co-Licensee’s CPR expires in 08/2020. All Helpers also have current CPR training. Licensee conducted last emergency drill on 11/04/19 and is properly logged. Licensee provides daily snacks and meals. Discipline policy is mainly redirection. All required postings are properly posted. Licensee, Co-Licensee, and Helpers have required proof of immunization on file and Mandated Reporter Training certificate on file. Children’s files were reviewed and are complete and up to date.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SIPOS, GIZELA & RENKEL, VANESSA
FACILITY NUMBER: 410517222
VISIT DATE: 11/06/2019
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During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Licensee was reminded about the Provider Information Notices (PINs) on CCLD website.
*Licensee was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com). Licensee states some of her Helpers will wait until training is available in Spanish.
*Licensee was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Licensee was given information regarding ‘Safe Sleep’ practices.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
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