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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621014
Report Date: 01/21/2020
Date Signed: 01/21/2020 09:33:40 AM

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:WYRICK, ROSLINDFACILITY NUMBER:
393621014
ADMINISTRATOR:WYRICK, ROSLINDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 688-0652
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 3DATE:
01/21/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Roslind WyrickTIME COMPLETED:
09:45 AM
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Licensing Program Analysts (LPAs) Fabiola Diaz and Amy Silva arrived at the above facility for the purpose of conducting a plan of correction inspection. LPAs met with licensee Roslind Wyrick. LPAs observed 3 children supervised by Roslind Wyrick. Roslind's husband was present during the visit.

A deficiency was cited during the facility's annual inspection on January 6th, 2020 for an un-fingerprinted individual residing in the home. Licensee provided LPA with proof that the individual is now fingerprinted. On today's date LPAs verified that the individual is fingerprint cleared.

Exit interview was conducted. Plan of correction letter provided to Licensee. Notice of Site visit was posted and appeal rights provided to the licensee.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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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