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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370803020
Report Date: 02/24/2022
Date Signed: 02/25/2022 08:54:39 AM


Document Has Been Signed on 02/25/2022 08:54 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:BAUM FAMILY CARE HOMEFACILITY NUMBER:
370803020
ADMINISTRATOR:BAUM, RONALD&CHERYLFACILITY TYPE:
735
ADDRESS:9627 RANCHO MIRAGE LANETELEPHONE:
(619) 390-8978
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY:6CENSUS: 6DATE:
02/24/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Cherly BaumTIME COMPLETED:
02:40 PM
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Licensing Program Analyst, Debbie Correia and Infection Control Specialist Sandra Brackman from the County of San Diego HAI Program, conducted an on-site visit. The team identified themselves and discussed the purpose of the visit with Licensee Cheryl Baum and Direct Support Professional (DSP) Carrie Baum.

The Department and HAI Nurse conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Licensee Baum and DSP Carrie Baum and conducted a walk-through of the facility. A debriefing was conducted with at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Licensee Baum and DSP Baum, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), will be provided to Licensee Baum and DSP Baum via electronic mail. An electronic read reply confirms receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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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