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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808350
Report Date: 10/24/2022
Date Signed: 10/24/2022 11:27:08 PM

Document Has Been Signed on 10/24/2022 11:27 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:BAUM ADULT RESIDENTIAL FACILITY #2FACILITY NUMBER:
370808350
ADMINISTRATOR:BAUM, CHERYLFACILITY TYPE:
735
ADDRESS:9680 PETITE LANETELEPHONE:
(619) 561-7524
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 6CENSUS: 6DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee Cheryl and Administrator Bonnie BaumTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced annual required licensing inspection. LPA was granted entry into the facility by Licensee Cheryl and Administrator Carrie Baum after identifying herself and disclosing the purpose of the visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with COVID-19 infection control practices.

LPA Correia, accompanied by Administrator and Licensee Baum, conducted a facility tour inside and out. LPA reviewed the facility’s Infection Control Plan for an Epidemic Outbreak Specific to COVID-19, including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19 positive Clients and the facility's plans for Infection Control and Physical Distancing. LPA 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 practices.

LPA reviewed items pertaining to universal entry for routine symptom screening; initiated for staff, residents and visitors; signs posted at the facility entrance 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; and an adequate supply of PPE.

No deficiencies were cited during this visit. An exit interview was conducted with Cheryl and Carrie Baum. LPA provided a copy of this report, along with the Licensee Rights (9058 01/16). Signature on this document confirms receipt of the reports.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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