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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409097
Report Date: 10/07/2022
Date Signed: 11/04/2022 10:01:34 AM


Document Has Been Signed on 11/04/2022 10:01 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:KURPIEWSKI, HELENFACILITY NUMBER:
434409097
ADMINISTRATOR:KURPIEWSKI, HELENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 472-4958
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 0DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), James Santos arrived at the day care home today to conduct the Required 1 Year inspection. Upon LPA's arrival at the home, a male individual opened the door. LPA introduced himself and discussed with the individual the purpose of the visit. The individual stated they bought the home from the previous owner (Licensee, Helen Kurpiewski) back in March 2022 and that the home is no longer a day care home.

LPA was able to obtain the Licensee's contact tel# (408-472-4958) from the new home owner. LPA was able to speak with Licensee, Helen Kurpiewski on the phone and she confirmed that she sold her home early this year and she has moved to Carmichael, CA. LPA asked Licensee if she notified CCL that she sold her home and closed her day care. Licensee stated she thought she notified CCL but does not remember.

LPA told Licensee that her facility/licensee will be closed. LPA obtained the Licensee's mailing address:

Helen Kurpiewski
6409 Lincoln Avenue
Carmichael, CA 95608

LPA told Licensee that a closure letter will be mailed to her address.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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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