093617355-3-7-2024-03-CC-SMAX-D35U76-20240307141926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093617355
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:19:32 PM

Document Has Been Signed on 03/07/2024 02:19 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	NORDBY, TRACY A.		FACILITY NUMBER:	093617355
ADMINISTRATOR:	NORDBY, TRACY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 919-6466
CITY:	GEORGETOWN	STATE: CA	ZIP CODE:	95634
CAPACITY:	14	CENSUS: 11	DATE:	03/07/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Tracy Nordby		TIME COMPLETED:	02:35 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Soleil Marx and Loraine Perez met with Licensee, Tracy Nordby, for an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 07:00 AM to 05:30 PM. This facility has two waivers on file for decking and an irrigation ditch.

Upon LPA arrival there was a census of 11 napping children in care being supervised by the licensee. Licensee stated a staff member had just left due to a medical emergency and that another staff was on their way to the facility. LPAs observed an assistant arrived to the facility to assist the licensee approximately five minutes post LPA arrival.

A health and safety inspection was conducted in the areas accessible to children. The off-limits areas include: backyard, basement, decking, all bedrooms and kitchen. Licensee understands that children may never enter off-limits areas. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys within the home. LPA observed fireplace and stairs within the home are properly barricaded to meet regulations. Licensee stated there are no firearms on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPAs observed a pool on the premises, in the off-limits backyard, that is properly fenced to meet regulations. LPAs observed a hot tub on the off-limits lower decking which is secured to meet regulation with a hard top cover that locks on all four sides.

LPA observed all required postings, a children's roster and fire drill log, the last fire drill was conducted 02/2024. LPAs reviewed records of children’s files and staff files, all which contained the required documentation. Licensee has current EMSA approved pediatric CPR/First Aid training, which expires 03/2024. Licensee has current Mandated Reporter Training, which expires 08/2025. Licensee understands both CPR and mandated reporter training's’ must be completed every two years.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NORDBY, TRACY A.	FACILITY NUMBER: 093617355
	VISIT DATE: 03/07/2024

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Licensee was reminded that all adults 18 and over living or working in the home, 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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.

One Type B Title 22 deficiency is being cited on 809-D

During the exit interview, the licensee, Tracy Nordby, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee, Tracy Nordby. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/07/2024 02:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NORDBY, TRACY A.	FACILITY NUMBER: 093617355
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(e)

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the Licensee did not ensure she was in compliance with capacity requirements by not having an assistant present with 11 children which poses a potential Health, Safety, or Personal Rights risk to persons in care.
	POC Due Date: 03/07/2024
	Plan of Correction
1 2 3 4	Deficiency cleared at time of inspection. LPAs observed an assistant arrived to assist the Licensee within 5 minutes of LPA arrival to cover for the assistant that had left for a medical emergency.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC809 (FAS) - (06/04)

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