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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134602407
Report Date: 12/07/2023
Date Signed: 12/07/2023 02:30:15 PM

Document Has Been Signed on 12/07/2023 02:30 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: 4DATE:
12/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Keith Baird, LicenseeTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Required Annual Inspection. LPA introduced herself and was granted entry into the facility by Keith Baird, Licensee, to whom LPA disclosed the purpose of the visit.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, all of whom must be ambulatory. During today’s inspection, there were a total of four (4) clients residing in the home.

LPA, accompanied by the licensee, toured the interior and exterior of the facility and inspected rooms. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Equipment inspected was in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s internal temperature was 72 degrees Fahrenheit. Hot water temperature at sink accessible to clients measured at 109.9 degrees Fahrenheit.



Refrigerator and freezers were operational. There was 2 days of perishable food and 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in a locked closet.

No pools or bodies of water were observed on the premises. There are firearms and ammunition present at the facility. According to the licensee, firearms and ammunition are stored in a locked safe and cabinet in the facility. Smoke alarms, carbon monoxide detector, and facility telephone were in working order. Fire extinguisher present in the home was replaced within the last 3 months. First aid kit was complete and readily accessible.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BAIRD BOARD AND CARE #1
FACILITY NUMBER: 134602407
VISIT DATE: 12/07/2023
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Required licensing postings were observed in a visible area in the facility.

LPA interviewed staff and two clients who were present during the visit. The interviews did not raise any significant licensing concerns. LPA reviewed records/files. Staff are current on training requirements. Client files contained required documents. Confidential records were stored in a locked closet.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Keith Baird, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit. Keith’s signature on this report acknowledges receipt of copies of the report and rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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