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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621014
Report Date: 08/10/2020
Date Signed: 08/10/2020 08:57:23 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: 0DATE:
08/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Roslind WyrickTIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Justin Denton 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 8/10/2020 at 08:30 A.M. There were no children present during today's tele-inspection..

Today's tele-inspection was requested to change the downstairs bathroom back to on-limits and the second floor (mid-floor) bathroom back to off-limits, as was the case on 8/5/2020. The downstairs 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.

As of today's date, 8/10/2020, LPA Denton has approved the downstairs 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 second floor bathroom was made off-limits.

An exit interview was conducted. A copy of this report 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 will be accepted in lieu of a signature due to COVID-19.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020
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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