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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621014
Report Date: 01/15/2020
Date Signed: 01/15/2020 09:31:33 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:
01/15/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Roslind WyrickTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Christopher Jackson conducted an unannounced plan of correction inspection for a deficiency cited in the family home day care. LPA met with licensee, Roslind Wyrick. Three children were present at time of inspection.

The purpose of the inspection was to clear the deficiency cited on January 06, 2020: Stairs not properly barricaded. Based upon today’s inspection, LPA observed that the stairs were properly barricaded. The deficiency is cleared at time of inspection.

An exit interview was conducted with licensee. Appeal rights reviewed and provided. Notice of Site visit was posted and must remain for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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