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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134602407
Report Date: 12/27/2021
Date Signed: 12/27/2021 04:19:30 PM

Document Has Been Signed on 12/27/2021 04:19 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BAIRD BOARD AND CARE #1FACILITY NUMBER:
134602407
ADMINISTRATOR:BAIRD, KEITHFACILITY TYPE:
735
ADDRESS:1937 MOUNT SIGNAL AVETELEPHONE:
(442) 229-9088
CITY:SEELEYSTATE: CAZIP CODE:
92273
CAPACITY: 4CENSUS: 3DATE:
12/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Keith Baird, LicenseeTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Miller and LPA Martinez conducted an unannounced annual required inspection on today's date. LPAs were greeted at the front door by Licensee Keith Baird, and granted entry after identifying themselves and disclosing the purpose of the visit. Licensee Keith Baird arrived to give LPAs an overall tour of the facility. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other requirements most relevant to protecting the health of residents in care and staff, including in the area of infection control practices.

LPAs reviewed with Licensee Keith Baird the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC808) including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility Plans for Infection Control, and Physical Distancing. LPAs assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety. LPAs observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment).

Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC808. No deficiencies were observed during today's visit. An exit interview was conducted with Licensee and a copy of this report along with Licensee/Appeal Rights (LIC9058 FAS 01/16) was provided via email; facility representative expressed that they would send LPA Miller a confirmation email upon receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2021
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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