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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198012957
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:10:47 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
10/07/2024 and conducted by Evaluator Randy Derraco
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20241007143612
FACILITY NAME:BLAYLOCK FAMILY CHILD CAREFACILITY NUMBER:
198012957
ADMINISTRATOR:BLAYLOCK, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 583-8551
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY:14CENSUS: 1DATE:
01/23/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee - Donna BlaylockTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee spoke inappropriately to child - Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced complaint inspection to the above mentioned facility on 01/23/24. LPA arrived at the facility at 9:15 AM and was met by licensee, Donna Blaylock, who guided analyst on a tour of the home. LPA observed 1 additional adult and 1 child in care. The home was observed to be clean and free of defects.

The purpose of this visit is to deliver findings to the above mentioned allegation. During the course of the investigation, LPA conducted interviews, reviewed records and made observations. Individuals interviewed state that they do not have concerns with how the licensee communicates to the children. Individuals interivewed were unable to corroborate that the licensee or any staff member speaks inappropriately to children in care. LPA observed that adults present in the home have criminal background clearance and have been associated to the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is
(page 1 of 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 54-CC-20241007143612
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 198012957
VISIT DATE: 01/23/2025
NARRATIVE
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unsubstantiated

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

Exit interview conducted and report reviewed with licensee, Donna Blaylock.


(page 2 of 2)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2