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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621014
Report Date: 08/06/2020
Date Signed: 08/06/2020 10:51:52 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: 6DATE:
08/06/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Roslind WyrickTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a case management tele-inspection via Google Duo with licensee, Roslind Wyrick, due to COVID-19 in lieu of an on-site visit. Inspection took place on 8/06/2020 at 10:30 A.M. During today's tele-inspection, there were 6 children present in care.

Today's tele-inspection was requested to change the second floor (mid-floor) bathroom to on-limits and the downstairs bathroom to off-limits. The second floor bathroom was inspected by LPA via Google Duo and was determined to be in compliance with Title 22 regulations. Licensee stated the bathroom will be inspected regularly by licensee and will ensure it remains in operable and safe conditions and in compliance with Title 22. Licensee stated that the children will be accompanied up the stairs to the bathroom.

As of today's date, 8/06/2020, LPA Diaz has approved the second floor bathroom to become on-limits and to be used by children in care and will change the license to reflect the change that was made. The downstairs bathroom was made off-limits. LPA advised licensee that she will be sent a new license to display in her home. Licensee stated she will be providing LPA with an updated facility sketch to show the changes.

An exit interview was conducted. A copy of this report and a Notice of Site Visit was e-mailed to the licensee to keep on file at the facility. A “read receipt” and/or an e-mail from licensee stating licensee has read this report is in lieu of a signature due to COVID-19.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020
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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