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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700400
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:11:48 PM


Document Has Been Signed on 02/10/2023 01:11 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:BALDWIN ACADEMYFACILITY NUMBER:
376700400
ADMINISTRATOR:DARLA RODRIGUEZFACILITY TYPE:
850
ADDRESS:1752 HORNBLEND STREETTELEPHONE:
(858) 270-5995
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:75CENSUS: 33DATE:
02/10/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Linda SarmientoTIME COMPLETED:
01:30 PM
NARRATIVE
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On 2/10/23 at 12:00 PM Licensing Program Analysts (LPAs) Adrian Mangina and Nancy Diaz conducted an unannounced Case Management inspection, for reported Lead Exceedance. LPAs also remeasured all outdoor space. LPAs Mangina and Diaz met with owner Herbert Perico. Also present in the facility were 33 daycare children and 5 teachers/staff. Facility was within ratio & capacity. LPA interviewed staff and examined the faucets and drinking fountains deemed an Action Level Exceedance. Facility provided facility sketch and required forms (LIC 9275/9276) to Department on 12/7/22.

Faucets and drinking fountains reported with 5.5 ppb or greater lead exceedance levels were as follows:

Big Nest Faucet C-CF-P 7.3.ppb

Big Nest Fountain D-CD-P 8.7 ppb

Canary Kitchen faucet L-KD-P 24 ppb

Canaries Kitchen fountain L-KF-P 28 ppb

Robins kitchen faucet H-CF-P 7.1 ppb

Robins Fountain H-CF-P 61 ppb

Owner reported, all fountains and facuets in exceedance were replaced and drinking water filters installed. Prior to replacement, all fountains/faucet were shut off and masked. Children drink bottled water supplied by Sparkletts. All staff were informed not to use the faucets for drinking water fountains for food preparation.

See LIC809D for Type B deficiency cited.

Exit interview conducted and report was reviewed with the owner Herbert Perico. A copy of PIN 21-21-CCP was provided. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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Document Has Been Signed on 02/10/2023 01:11 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: BALDWIN ACADEMY
FACILITY NUMBER: 376700400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited

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Written Directives: A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement is not met as evidenced by:
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Owner states Faucets C-CF-P, L-KD-P, H-CF-P and fountains D-CD-P, L-KF-P, and H-CF-P, were replaced and restested 2/9/23, Owner will provide results to LPA no later than 2/24/23 and take additional action as needed.
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Based on water testing results and interviews, facility tested over the Action Level Exceedance level at 3 fountains, and 3 kitchen faucets. This poses a potential health, safety or personal rights risk to children 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.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
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