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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425030
Report Date: 05/20/2022
Date Signed: 05/20/2022 12:54:46 PM


Document Has Been Signed on 05/20/2022 12:54 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AVATAR RETIREMENT HOMEFACILITY NUMBER:
336425030
ADMINISTRATOR:JAMAL ALKAWASSFACILITY TYPE:
740
ADDRESS:44645 SAN ONOFRE AVENUETELEPHONE:
(760) 340-5191
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:10CENSUS: 8DATE:
05/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Yolanda Alkawass, LicenseeTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to conduct a health and safety visit in relation to complaint #18-AS-20220518163045. The LPA met with Yolanda Alkawass, Licensee, and informed her of the purpose of her visit.

The LPA toured the facility, accompanied by Alkawass. LPA conducted resident interviews. No health and safety concerns were observed at time of visit.

This report was reviewed with Alkawass and a copy was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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