198012957-3-5-2021-54-CC-TCON-BYTQQP-20210305112241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198012957
Report Date: 01/29/2021
Date Signed: 03/05/2021 11:19:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2020 and conducted by Evaluator Reiko Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20201110154603

FACILITY NAME:	BLAYLOCK FAMILY CHILD CARE		FACILITY NUMBER:	198012957
ADMINISTRATOR:	BLAYLOCK, DONNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 583-8551
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90001
CAPACITY:	14	CENSUS: 7	DATE:	01/29/2021
		UNANNOUNCED	TIME BEGAN:	01:56 PM
MET WITH:	Donna Blaylock; Licensee		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Personal Rights_Inappropriate interaction between children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced complaint investigation to deliver findings for the allegations above via TELE_INSPECTION using FACETIME due to SOE. LPA met with Licensee Donna Blaylock who guided LPA on a tour of the facility. LPA observed seven children in care including one Licensee Assistant(S4). LPA interviewed C4 during today’s inspection. During the course of this investigation LPA observed children during snack time, class instruction(distance learning) and nap time.
No declarations were made during confidential interviews with staff, children and parents. In addition, LPA observed children in care physically distanced with school-age children in the rear bedroom.
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview was conducted with Licensee Donna Blaylock and Appeal Rights were provided and discussed. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko Jones	TELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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