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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012957
Report Date: 02/06/2026
Date Signed: 02/06/2026 05:26:04 PM

Document Has Been Signed on 02/06/2026 05:26 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:BLAYLOCK FAMILY CHILD CAREFACILITY NUMBER:
198012957
ADMINISTRATOR/
DIRECTOR:		BLAYLOCK, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 583-8551
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/06/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Donna Blaylock - LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On February 6, 2026, 2025 at 2:00 PM Licensing Program Analyst (LPA) Franchesca White conducted an unannounced Case management Inspection for the purpose of following up on an Unusual Incident Report (UIR). LPA announced purpose of inspection and was allowed entry to facility by Donna Blaylock, Licensee. LPA toured of the facility and observed 4 children present with 2 staff upon arrival.

The UIR received 5/20/25 involving Child One (C1) was investigated by Community Care Licensing Investigation Branch (IB) Investigator, D. Douglas. IB investigation consisted of interviews with Licensee, daycare staff, Los Angeles Police department (LAPD) and other witnesses. Adult One (A1) is alleged to have inappropriately touched C1.

During the investigation Licensee admitted she allowed A1 to enter the facility during the same timeframe C1 was enrolled. Records show that A1 does not have a fingerprint clearance. It was determined that A1 had to walk through the daycare area to get to the back property, allowing a chance to interact with C1. Per Licensee, A1 does not interact with the daycare children and she did not witness inappropriate actions. Witnesses identified A1 by picture and name and confirmed he was at the facility during the timeframe of the incident.

A non-compliance conference will be scheduled with Licensee.


C1 and A1 are identified on Confidential Names Form (LIC811)

Licensee allowed uncleared (A1) in the facility without required criminal background clearance. A violation regarding Criminal Background Clearance warrants a civil penalty of $100 and is hereby assessed, see LIC 421BG or other form used.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2026
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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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)
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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: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 198012957
VISIT DATE: 02/06/2026
NARRATIVE
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LPA Franchesca White informed licensee Donna Blaylock that this report dated February 6, 2026 document(s) (3) Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA White informed the licensee Donna Blaylock to provide a copy of this licensing report dated February 6, 2026 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. Failure to post will result in a civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Donna Blaylock.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/23/2026 10:14 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/18/2026 03:42 PM


Created By: Alicia Mooberry On 02/06/2026 at 04:07 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 198012957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2026
Section Cited
CCR
102423(a)

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THIS IS AN AMENDED REPORT
Each child receiving services from a family child care home shall have certain rights that shall .... These rights include, but are not limited to, the following: (2)To receive safe…accommodations…. This requirement is not met as evidenced by:
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Licensee provided a written statement of understanding that no uncleared adult should be around day care children.
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Per IB Investigation licensee allowed uncleared adult A1 to access the facility, resulting in C1 being touched inappropriately without consent. This poses an immediate health, safety or personal rights risk to persons in care.
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Type A
02/06/2026
Section Cited
CCR102417(a)

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(a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times…

This requirement is not met as evidenced by:
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Licensee provided a written statement of understanding that she must be present in the home to provide supervision to the children at all times.
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Per IB Investigation licensee did not observe A1 interact with C1, resulting in C1 being touched inappropriately. This poses an immediate health, safety or personal rights risk to persons in care. An immediate civil penalty of $500 was issued.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/06/2026 05:26 PM - It Cannot Be Edited


Created By: Franchesca White On 02/06/2026 at 04:58 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: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 198012957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2026
Section Cited
CCR
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person ...exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant .... specified in subdivision (b) who is not exempt from fingerprinting shall be fingerprinted... This requirement is not met as evidenced by:
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Liensee provided a written statement of understnding that no uncleared adult should be around day care children.
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Based on record review licensee allowed A1 access to the facility without a criminal background clearance. Witness confirmed interaction with daycare children. This poses an immediate health, safety or personal rights risk to persons in care.
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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:
Franchesca White
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2026


LIC809 (FAS) - (06/04)
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