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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217264
Report Date: 02/13/2025
Date Signed: 02/14/2025 08:25:44 AM

Document Has Been Signed on 02/14/2025 08:25 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MARTINEZ ALBA FAMILY CHILD CAREFACILITY NUMBER:
426217264
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/13/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Dora Martinez Alba TIME VISIT/
INSPECTION COMPLETED:
11:44 AM
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OnFebruary 13, 2025, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing inspection at the above-mentioned residence. LPA met with applicant Dora Martinez Alba and informed them the purpose of the inspection. At the time of the inspection no children were present. Applicant informs LPA the intention to provide care for children ages 3 months - 12 years old and to have operating hours of 5AM-5:30PM, Monday to Friday.

LPA in the company of the applicant toured the interior and exterior of the residence in its entirety. The residence is a 2 story apartment consisting of 3 bedroom, 2 bathrooms, living room, dining area, kitchen, laundry room and patio. The home's living room, dining area, downstairs bathroom, and part of the patio will be used for child care purposes while the remainder of the home will be excluded from care.

LPA observed the interior of the home to be clean and orderly. LPA observed the living room to have sufficient space and ventilation for children in care. LPA observed the living room to have plenty of children's equipment and to be free of hazards. LPA observed the dining area to be free of hazards as well. LPA observed the kitchen to be accessible and that all lower cabinets and drawers are secured with child proof locks. LPA observed sharps to be stored in an elevated cabinet beyond the reach of children. LPA observed the laundry room to be accessible as well and that all detergents and cleaning products are located in an elevated cabinet, outside the reach of children. LPA reminded applicant they must insure all cleaning products are inaccessible to children in care. LPA observed the bathroom to be used for children to be clean and free of hazards. LPA observed the stairs to be blocked with a child proof gate. LPA notes the bedrooms are made inaccessible with the child proof gate since all bedrooms are located on the second floor. LPA reminded applicant that in order for areas to be considered inaccessible they must have the child gate up when children are present.

LPA observed the area of the patio for children to be completely enclosed. LPA observed the children's area to CONTINUED PAGE 2
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTINEZ ALBA FAMILY CHILD CARE
FACILITY NUMBER: 426217264
VISIT DATE: 02/13/2025
NARRATIVE
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be free of hazards. LPA observed a gate making the off limits area of the patio to be inaccessible to children.

LPA observed a fire extinguisher that satisfies regulation (2A10BC) which was purchased on 8/28/2024. LPA reminded applicant that it is their responsibility to purchase or service a regulation fire extinguisher annually. LPA observed the home has a combination smoke and carbon monoxide detector which was tested at 11:00 AM and found in working order. Applicant stated that there are no fire arms in the home

LPA's record review revealed applicant completed Preventative Health Training on 9/22/24 and Mandated Reporter Training on 9/3/24. Further, applicant completed Pediatric CPR/First Aid (EMSA approved) on 8/31/24 and the FCCH orientation on 9/26/24. LPA reminded applicant of the obligation to maintain current training and certification.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

CONTINUED PAGE 3
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MARTINEZ ALBA FAMILY CHILD CARE
FACILITY NUMBER: 426217264
VISIT DATE: 02/13/2025
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LPA reviewed with applicants 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. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant 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 applicant 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. Applicant was informed baby walkers, jumpers, bouncers, exersaucers, or any similar articles are not permitted on the premises during day care hours.

On this date, 2/13/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The home meets Title 22 of CCR requirements for a Small Family Child Care License. Effective date of the license will be noted as the present 2/13/2025.

Exit interview conducted and report was reviewed with applicant Dora Martinez Alba. Notice of site visit was given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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