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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700628
Report Date: 12/15/2025
Date Signed: 12/15/2025 11:45:40 AM

Document Has Been Signed on 12/15/2025 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BLAYLOCK FAMILY CHILD CAREFACILITY NUMBER:
197700628
ADMINISTRATOR/
DIRECTOR:		SHAWNTIA BLAYLOCKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 583-5257
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
12/15/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Patricia McKessonTIME VISIT/
INSPECTION COMPLETED:
11:44 AM
NARRATIVE
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On December 15, 2025, at 9:25 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted an unannounced annual inspection at Blaylock Family Child Care Home to assess its ability to meet compliance with California Code of Regulations (CCR) Title 22, Health, and Safety requirements. LPA rang the doorbell and met with Patricia McKesson, the licensee’s assistant (Assistant #1, A#1). A#1 stated that the licensee is currently at work. LPA was granted access to the facility. The LPA provided copies of the LIC 126 Entrance Checklist Form. At around 9:30 A.M., the licensee, Shawntia Blaylock, called A#1 and the LPA spoke with the licensee. During the conversation with the licensee, the licensee stated that licensee is doing therapy. Licensee also stated that the licensee, licensee’s assistant, and the children’s files are in a lock cabinet and the assistant do not have access to the files. LPA told the licensee that if LPA could not complete the inspection today, LPA will again conduct an unannounced annual inspection. Licensee understood and agreed with the LPA.

After the LPA’s conversation with the licensee, A#1 guided the analyst on a tour of the day care areas. The day care takes place in the following areas of the home: family room (main care), bathroom #1, and back yard (outdoor play area). Incidental Medical Services (IMS) were discussed with A#1. Licensing fees current.

Per A#1, licensee’s days and hours of operation are 23 hours, seven days a week. Currently living in the home are the licensee, licensee’s adult son, and two minor children (9 and 10). Per A#1, licensee is currently providing transportation to after school children. LPA informed A#1 that licensee must have a current driver’s license, vehicle registration, and car insurance when transporting children in care. During this visit, LPA observed 2 children with the licensee’s two assistants providing care and supervision. Also,
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2025
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 5
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 197700628
VISIT DATE: 12/15/2025
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during this visit, LPA observed four adults (licensee’s adult son, 2 female assistants, 1 adult female - AF) in the home. Per A#1, AF is just visiting for the holidays.

Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. The smoke detector and carbon monoxide detector are in operable condition (tested 10:49 A.M.). The facility has a 3-A:40-B:C type of fire extinguisher. The kitchen is off limits to children in care.

Per A#1, the licensee does not own firearms, and no one smokes in the facility. LPA observed cleaning products stored inside the lower kitchen cabinets with child safety latch. Knives are stored inside a plastic container on top of the refrigerator. Per A#1, there are no household medications, and no medications are provided to children in care. A#1 also stated that the licensee provides meals and snacks to children in care.

The facility is a two-story house. Per A#1, all upstairs rooms are off-limits. There is a fireplace in the living room of the facility, and it is covered by a glass door. The home has central heating and air conditioning units.

Based on records review, the fire/earthquake drills were conducted today, November 17, 2025, at 10:15 A.M.


LPA observed safe and age-appropriate toys, small tables and chairs, cubbies, blocks, small chairs used for time out, television, and other toys in the facility. LPA also observed 15 sleeping cots stored in the garage.



Licensee has first aid kit with emergency kit guide, scissors, tweezers, and other supplies. The first aid kit is stored inside the closet next to the bathroom for children in care. LPA also observed a thermometer.

The licensee was advised that baby bouncers, saucer chairs, or any recalled and or banned toys or sleep/
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 197700628
VISIT DATE: 12/15/2025
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play equipment are prohibited on the premises. Licensee is advised to check for fixture, furniture and equipment that have been banned or recalled by the United States Consumer Product Safety Commission.

Bathroom: Toilet, sink and faucet were clean and operable. LPA did not observe razors and/or sharp objects, shampoos, mouthwash, medications, perfumes, air freshener, nail polish and nail remover that will pose a health and safety risk to children in care. LPA observed a cleaning product inside the locked lower bathroom cabinets.



Licensee stated that when a child shows signs of illness, the child is separated from other children in the licensee’s office between the living room and kitchen of the facility.

Pets: LPA did not observe pets in the facility.

Backyard: The facility has no body of water in the backyard. LPA did not observe body of water in the backyard. The backyard has a covered patio and age-appropriate toys and play equipment. LPA observed rideable toy cars, kitchen set toys, and a slide in the backyard and side yard.

At the time of inspection, Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be emailed to unusualIncidentreport@dss.ca.gov

Review of records to be maintained: LPA reviewed with licensee’s assistant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA was not able to review the children’s files, licensee, and assistant’s files due to the files are inside a lock cabinet in the licensee’s office. However, LPA observed the licensee has expired mandated reporter training dated 08/03/2023. Assistant #1 has a current mandated reporter training dated 09/09/2024. LPA was not able to review the rest of the files.

Also, LPA was not able to review the facility roster due to the file is inside a lock cabinet.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BLAYLOCK FAMILY CHILD CARE
FACILITY NUMBER: 197700628
VISIT DATE: 12/15/2025
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Licensee and other adults living and working in the home have received criminal record clearance.

Due to the unavailability of the children, licensee, assistant’s files, and other records, LPA will continue to conduct an annual inspection continuation at a later date.

No deficiencies were cited during this visit. An exit Interview and discussion of observations were conducted with the licensee.



Notice of Site Visit: A Notice of Site Visit (LIC 9213 was given and must remain posted for 30 days.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this Report was reviewed, and Appeal Rights were also provided to licensee’s assistant, Patricia McKesson.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025
LIC809 (FAS) - (06/04)
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