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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624271
Report Date: 08/05/2022
Date Signed: 08/05/2022 11:32:00 AM

Document Has Been Signed on 08/05/2022 11:32 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KURPIEWSKI, ERNESTINAFACILITY NUMBER:
343624271
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ernestina KurpiewskiTIME COMPLETED:
11:45 AM
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At 10:45 a.m. on Friday, August 5th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Ernestina (Lucy) Kurpiewski for the purpose of an unannounced Case Management - Licensee Initiated inspection. Licensee has requested an increase in capacity from 8 to 14 children. A fire clearance has been received by LPA Guerra and is on file with the department. 2 infants were present at the facility during time of inspection. Licensee stated that 2 additional school age children were at an off site field trip with an Assistant.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the Master Bedroom, Second Bedroom, garage, and side yard. Kitchen/Dining room was previously designated as off limits, but will now be on limits. LPA requested an updated facility sketch. LPA discussed ratios for a large capacity, and documents required for staff or adult assistants.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. This facility evaluation report was reviewed and discussed with the licensee, Ernestina Kurpiewski. A Notice of Site Visit was provided and shall remain posted for 30 days for parental review.

Effective today, 8/5/2022, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in transitional kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, the facility reverts back to the ratios of a small capacity.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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