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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425030
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:51:54 PM


Document Has Been Signed on 06/29/2022 02:51 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: 9DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Yolanda Alkawass, Licensee
Jamal Alkawass, Administrator		TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Licensee, Yolanda Alkawass who was informed of the purpose of the visit. At the time of visit there was Administrator Jamal Alkawass, 1 Trainee and 9 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA did not observe Covid-19 postings posted throughout the facility. Yolanda agreed to post the Covid-19 postings before the end of the day. The facility has an adequate amount of hand hygiene supplies (soap, and hand sanitizer) in all restrooms. LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home. Yolanda was informed about the annual fees due. Yolanda agreed to pay the annual fees before the end of the day.

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA did not observed PPE supplies. Yolanda agreed to buy PPE supplies before the end of the day. No deficiencies noted at the time of visit.

An exit interview was conducted, and a copy of this report was reviewed and provided to Yolanda Alkawass

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
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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