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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621014
Report Date: 01/06/2020
Date Signed: 01/06/2020 12:34:23 PM

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: 5DATE:
01/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Roslind WyrickTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Fabiola Diaz met with Licensee Roslind Wyrick on 1/06/2020 at 9:55 AM for the purpose of an unannounced annual random inspection. LPA observed a new un-finger printed adult resident in the home. Licensee stated it is her adult daughter. Licensee stated her adult daughter just returned to live with her. LPA did not observe adult daughter interacting with children in care. LPA observed all other adult residents have criminal record clearances. Roslind had two adult nieces and a great nephew minor visiting during the inspection. Visitors remained in the top off-limit floor. Census at the time of inspection was 5 children.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include: entire third floor (upper level floor), bathroom in the second floor (entry floor), and all of the bedrooms in the 1st floor (lower level floor), and backyard. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home.There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Stairs were not barricaded following Title 22 regulations. The play equipment appears to be in good repair.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA discussed documentation of a roster and documentation that a fire drill is conducted at least once every six months. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu were discussed. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 4/13/2020 and Child Care Provider Mandated Reporter was verified.
Report continues on 809-C.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: WYRICK, ROSLIND
FACILITY NUMBER: 393621014
VISIT DATE: 01/06/2020
NARRATIVE
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This provider is not currently providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Licensee can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with Licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form.



The following Title 22 Deficiency is being cited on the subsequent 809-D pages. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809-D in each child's file. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: WYRICK, ROSLIND
FACILITY NUMBER: 393621014
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2020
Section Cited

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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. This was evidenced by LPA observing the unfinger printed adult residing in the home.
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 Licensee stated her adult daughter just moved in. This poses an immediate health and safety risk to children in care.
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Type A
01/07/2020
Section Cited

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g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(3) Where children less than five years old are in care, stairs shall be fenced or barricaded.
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This was not met as evidenced by: LPA observed the house stairs not barricaded and not meeting title 22 regulations. This poses and immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3