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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093610128
Report Date: 08/25/2022
Date Signed: 09/12/2022 10:14:40 AM

Document Has Been Signed on 09/12/2022 10:14 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ROSS-HINTZE, LISAFACILITY NUMBER:
093610128
ADMINISTRATOR:ROSS-HINTZE, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 939-4486
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa Ross-HintzeTIME COMPLETED:
02:30 PM
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On 08/25/2022 at approximately 1:00PM Licensing Program Analyst (LPA) Arianna Manabat met with licensee Lisa Ross-Hintze for an unannounced annual / one year inspection. During the inspection there were no day care children. All individuals subject to criminal background review have obtained a criminal record clearance. The facility is open 9:15am-1:15pm Monday through Friday.

The home is a two-story home and the on-limits areas include the downstairs area with the off-limit areas are upstairs, laundry room, garage, pool area, and downstairs bathroom. The licensee stated that there are no firearms on the premises. The pool gate meets regulation requirements.

A health and safety inspection was conducted in the areas accessible to children. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPA observed all the required postings. LPA advised the licensee that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. LPA observed a fireplace within the facility and it is barricaded.

Licensee has all of her immunization records current. Children's roster and a current fire drill log were observed. Licensee's CPR/First aid card had an expiration date of 2024. Mandated Reporter Training for licensee had an expiration date of September 2022. Licensee understands training must be complete every two years. LPAs observed complete children's files.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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 Report continues on 809C................

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ROSS-HINTZE, LISA
FACILITY NUMBER: 093610128
VISIT DATE: 08/25/2022
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…… Continued from previous 809 page.....

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee does not accept infants in care as of today.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. No deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with the Licensee.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
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