<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610105
Report Date: 07/12/2024
Date Signed: 07/12/2024 03:31:23 PM

Document Has Been Signed on 07/12/2024 03:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BLANCHARD FAMILY CHILD CAREFACILITY NUMBER:
191610105
ADMINISTRATOR/
DIRECTOR:		ERNESTINE BLANCHARDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 715-1751
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:ERNESTINE BLANCHARD / LICENSEETIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random/ annual inspection at the above facility. LPA met with Licensee Ernestine Blanchard who allowed LPA entry to the facility. There were 5 children present. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon to Fri 6:00 AM - 6:00PM.

This is a two-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room with a barricaded fireplace, small den next to kitchen (day care room), garage (additional day care room), adult recreation room, jacuzzi room, front yard and backyard (fenced). The children use the downstairs bathroom located near the stairs by the small den room. Per licensee, areas off limits to children and parents include: all upstairs which includes the bedrooms and two restrooms, living room, dining room, adult rec. room and jacuzzi room.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. A guided tour was conducted by Licensee. The following was observed and reviewed during this inspection:

Garage room is used as a day care room, all required postings are in place in day care room. LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. The garage has stored cleaning components and disinfectants stored in the cabinet under the sink, inaccessible to children in care, a baby lock/latch is in place.The home also has an enclosed jacuzzi room next to the small den. LPA observed that the jacuzzi has a cover that can withstand the weight of a human and it is inaccessible to children in care with a locked door.
The home has two staircases, one located in the garage and one located in the den room, baby gates are placed at the bottom of each staircase to provide inaccessibility to the children in care.
(Page 1, continuation 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BLANCHARD FAMILY CHILD CARE
FACILITY NUMBER: 191610105
VISIT DATE: 07/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Kitchen was observed, additional cleaning components and disinfectants are in the cabinet under the sink inaccessible to children in care, a baby lock/latch is in place. Sharps are located in off limit dining room. Per Licensee, provides food for children in care. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

LPA Calderon observed Fire and Disaster Drill posted, last drill was conducted on 5/10/24. Fire extinguisher was last inspected on 4/10/24. LPA tested Carbon Monoxide and Smoke detector, devices were both found operable. Per Licensee, no pets are kept at the facility. Per Licensee, no children are on medication. LPA observed a landline and mobile cell phone on premises. Backyard was observed to have age appropriate materials for children in care, shade, and fruit trees used for educational learning.

LPA provided Licensee consultation per licensee request on 15min Infant Safe Sleep Log. LPA consulted Licensee on organization for files and provided Licensee with LIC311D.

LPA Calderon reviewed staff and children files. (5) children records (includes 1 infant) were reviewed. LIC995 Parent Rights missing in 5/5 files reviewed, deficiency cited. LPA reviewed a infant file, LPA gave a technical advisory and technical violations on staff and children records. Infant was not present during time of visit, LPA requested 15 min sleep log, Licensee was not able to provide LPA with log, deficiency cited.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
(Page 2, Cont 809-C)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/12/2024 03:31 PM - It Cannot Be Edited


Created By: Ashley Calderon On 07/12/2024 at 02:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BLANCHARD FAMILY CHILD CARE
FACILITY NUMBER: 191610105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA Calderon observation during record review child #1-#5 did not have LIC955A form in reocrds, the licensee did not comply with the section cited above in [5] out of [5] persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2024
Plan of Correction
1
2
3
4
LPA provided LIC955A form and instructed to have children guardians sign from. Licensee will provided form to parents and will place in children files. Will send picture of 5/5 children's LIC955A form to LPA by POC due date.

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:Valarie Cook
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 07/12/2024 03:31 PM - It Cannot Be Edited


Created By: Ashley Calderon On 07/12/2024 at 02:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BLANCHARD FAMILY CHILD CARE
FACILITY NUMBER: 191610105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation during record review LPA Calderon did not 15 min sleep log for child #2, Licensee stated is not consistant with log for infants, the licensee did not comply with the section cited above in (1) out of (1) persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2024
Plan of Correction
1
2
3
4
LPA Calderon instructed licensee how to fill 15 min log, Licensee stated will log child sleep, and provide a 15 min sleep log.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Valarie Cook
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BLANCHARD FAMILY CHILD CARE
FACILITY NUMBER: 191610105
VISIT DATE: 07/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per California Code of Regulations Title 22, deficiencies provided on LIC 809-D page(s).

A notice of site visit was given and must remain posted for 30 days and Appeal Rights was provided.

Exit interview conducted and report was reviewed with the licensee Ernestine Blanchard.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5