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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314258
Report Date: 11/26/2024
Date Signed: 11/26/2024 10:24:02 AM

Document Has Been Signed on 11/26/2024 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:WICK, BRIANNEFACILITY NUMBER:
304314258
ADMINISTRATOR/
DIRECTOR:		WICK, BRIANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 374-3984
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee, Brianne Wick and Licensee's Husband, Ahmed ShoukryTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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An Informal Meeting was conducted on this day in the Orange Regional Office. Present during the meeting were Martha Malane, Licensing Program Manager (LPM), Cindy Nguyen, Licensing Program Analyst (LPA), Brianne Wick, Licensee and Ahmed Shoukry, Licensee’s husband. The purpose of this informal meeting is to facilitate the signing for the Department of Social Services State of California Declaration (CDSS No. 7824100003B) and the acknowledgement that Ms. Wick understands the conditions of Mr. Shoukry’s conditional exemption.

LPA read the Department of Social Services State of California Declaration (CDSS No. 7824100003B) for the conditional exemption with Ms Wick and Mr. Shoukry who stated they understood the conditional exemption.


Ms. Wick signed the Declaration and was provided a copy by LPA.

LPA provided Ms. Wick with a copy of the Stipulation and Waiver; and Order which indicates that a conditional exemption was granted for Ahmed Shoukry.

Exit interview was conducted with Brianne Wick, Licensee and Ahmed Shoukry, Licensee’s husband who stated they are in agreement with the above. A copy of the report was read, explained, and provided to facility representative, Brianne Wick. A signature on this form confirms receipt of the report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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