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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610105
Report Date: 09/29/2025
Date Signed: 09/29/2025 04:50:07 PM

Document Has Been Signed on 09/29/2025 04:50 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: 12CENSUS: 6DATE:
09/29/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:27 PM
MET WITH:Facility Representative Nida Nofies and Licensee Ernestine Blanchard TIME VISIT/
INSPECTION COMPLETED:
04:57 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random/ annual inspection at the above facility. LPA met with Facility Representative Nida Nofies. who allowed LPA entry to the facility. Shortly after Licensee Ernestine Blanchard met with LPA Calderon. LPA disclosed purpose of the visit to both representatives.

Upon arrival LPA observed (3) children present, (1) children whom was infants. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon to Fri 6:00 AM - 6:00PM. Upon entrance LPA provided the family child care entrance checklist.

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).
On limit: downstairs bathroom located near the stairs by the small den room.
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, garage is permitted by the city. LPA reviewed required posted documentation in the garage: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. (Pg 1/Cont...)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2025
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 10
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 10
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: 09/29/2025
NARRATIVE
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Based on Record review: Licensees Mandated Reporter Certification for Licensee expired on 4/15/25. Based on record review Licensee Blanchard has a Red Cross First aid/CPR/ AED instructor Recertfication Assessment. Mandated Reporter Certification for Staff Assistant, due to primary language not available to conduct, staff assistant is waived and Pediatric 1st aid and cpr expires 3/17/2025 and staff assistant #1 Had TB record and missing vaccinations for MMR and TDAP, per Staff Assistant #1 stated gave Licensee TB and needs to provide Tdap record and get shot for Measles, deficiency cited.

LPA provided LIC9150 Additional Children in Care due to Licensee was using an incorrect for to notify parents they are a Large FCC. Infant Child #3 in their file has LIC9227 Infant Sleep Plan. Infant Child #3 was observed sleeping, based on record review Child #3 does not have a consistent sleep log indicating 15 min check, per staff assistant #1 stated infant is on their second nap of the day, log was reviewed by LPA Calderon and incomplete missing nap time in the AM and deficiency cited.

LPA asked Licensee if they have Liability Insurance, Per Licensee at 2:57pm informed LPA Calderon Liability Insurance in Nov 2025 will be dropped and they can't provide it at the moment due to they need to find the Liability Bond Form, Licensee stated to LPA Calderon needs the information for parents to sign the Affidavit Regarding Liability Insurance form. LPA provided LIC282 regarding Affidavit of Liability Insur., 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.

(Pg 3)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 10
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: 09/29/2025
NARRATIVE
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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 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.

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. The cover meets ASTM F1346:91. During visit Per Licensee informed LPA Calderon the jacuzzi is empty and is not being used. LPA Calderon opened the jacuzzi cover and observed an empty jacuzzi. The jacuzzi is inaccessible to children in care with a locked door and a latch at the top of the door. LPA Calderon in the garage observed the fire extinguisher with service tag: 4/3/25. LPA reviewed fire/ disaster drill log posted and last drill conducted on July 2025. During visit due to napping children Carbon Monoxide and Smoke Alarm was not tested.

At 1:00pm Infant Child #3 was sleeping in play yard with no firm mattress and a blanket placed under child, LPA observed no fitted sheets, picture taken, deficiency cited. In addition, child #3 (infant) had one small blankets folded by their head and one burp cloth over their belly area and 1 wedge under the back Infant Child #3 propping child and there were various toys in the play yard with infant; block toy observed, a turquoise rattle with holes toy observed , baby wipes package, and a teddy bear stuff, deficiency cited. In addition infant play yard was observed to be placed under (2) hanging mobiles. pictures taken, deficiency cited.

No child on medication Per Licensee. LPA observed a screened barricade on the fireplace located in the living room. Home has central ventilation for air conditioning and heating. Licensee informed LPA provides food for the children. LPA observed the knives in the off limit dining room area on a high shelf and additional knives placed up high in kitchen cabinet. LPA Calderon found two Raid Poison Bottles at 2:29pm and 2:31pm, Red Raid Bottle #1 for Ants and Roaches found in garage on top of the children personal belonging cabinet and a Blue Raid Bottle for Fly's found on the kitchen cabinet, deficiency cited. LPA observed outdoor area, during visit Licensee removed poisons in the storage located in the side yard, the door has no key, Per Licensee will get a key for storage door. The children outside yard has a fence around the yard.

At 2:50pm (3) additional children (school age) were dropped off to the facility, making census (6). The facility was observed to have children toys, material and equipment inside and outside of the home. Per Licensee, no home has no firearms and weapons. (Pg 3)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC809 (FAS) - (06/04)
Page: 4 of 10
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: 09/29/2025
NARRATIVE
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  • 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).

LPA Ashley Calderon informed licensee Ernestine Blanchard that this report dated on 9/29/25 document(s) has 2 Type A citation(s). LPA Calderon informed the licensee Ernestine Blanchard to provide a copy of this licensing report dated 9/29/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. 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. (Pg 4)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 09/29/2025 04:50 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/29/2025 at 04:10 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: 09/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon found two Raid Poison Bottles at 2:29pm and 2:31pm, Red Raid Bottle #1 for Ants and Roaches found in garage on top of the children personal belonging cabinet and a Blue Raid Bottle for Fly's found on the kitchen cabinet,, the licensee did not comply with the section cited above in 2 out of 2 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Per Licensee will get someone to get a lock on the storage door located in the side yard area and will send a picture to LPA Calderon by poc due date.
Type A
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation at 1:00pm Infant Child #3 was sleeping in play yard with no firm mattress and a blanket placed under child, LPA observed no fitted sheets; the licensee did not comply with the section cited above in [1] out of [1] infant napping arrangements not meeting regulations which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
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Licensee informed LPA Calderon will send a picture of a new mattress and infant bed she will get and send 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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 09/29/2025 04:50 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/29/2025 at 04:10 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: 09/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review: Licensees Mandated Reporter Certification for Licensee expired on 4/15/25, the licensee did not comply with the section cited above in [1] out of [1] mandated reporter certficate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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Licensee will conduct Mandated Reporter training and send picture of certficiate to LPA Calderon by 10/10/25.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review Staff Assistant did not have TDAP and MMR record for immunizations, the licensee did not comply with the section cited above in [1] out of [1] incomplete staff file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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Staff Assistant will provide TDAP and MMR record for immunization staff file based on POC due date by 10/10/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 09/29/2025 04:50 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/29/2025 at 04:10 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: 09/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's 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).

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation 2 out of 3 files reviewed did not have LIC955A form in children files, the licensee did not comply with the section cited above in [2] out of [3] Parent Right form missing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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Licensee will get parents to sign and place in children files and send picture to LPA Calderon by poc due date.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA asked Licensee if they have Liability Insurance, Per Licensee at 2:57pm informed LPA Calderon Liability Insurance in Nov 2025 will be dropped and they can't provide it at the moment due to they need to find the Liability Bond Form, Licensee stated to LPA Calderon needs the information for parents to sign the Affidavit Regarding Liability Insurance form, the licensee did not comply with the section cited above in [3] out of [3] no proof of Liability Insurance and no Affavidt form which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2025
Plan of Correction
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2
3
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Affidavit Regarding Liability Insurance form was given to Licensee and Licensee will have parents sign form and send a copt to LPA Caldeorn 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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 09/29/2025 04:50 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/29/2025 at 04:10 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: 09/29/2025

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) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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2
3
4
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
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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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 09/29/2025 04:50 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/29/2025 at 04:35 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: 09/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
10245(b)(1)(B)
(b) Cribs or play yards shall be free from all loose articles and objects.
(1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place:
(B) The pacifier shall be specific to the infant it is being given to.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation play yard had loose items 6 total , rattle toy, stuffed animal bear, 1 burp cloth, folded blanket, a wedge palced under baby, a toy block and a pack of baby wipe and 2 hanging mobiles above crib, the licensee did not comply with the section cited above in [8] out of [8] items above and in crib with sleeping infant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2025
Plan of Correction
1
2
3
4
During visit staff assistant removed all items that were in the crib with the sleeping infant and picture will be sent of removed hanging mobiles by poc due date.
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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2025


LIC809 (FAS) - (06/04)
Page: 10 of 10