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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604489
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:31:35 PM

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:AVALON PALM CARE, INC. DBA AVALON PALMFACILITY NUMBER:
374604489
ADMINISTRATOR:WINBLAD, JASONFACILITY TYPE:
740
ADDRESS:3271 INNUIT AVETELEPHONE:
(619) 757-3918
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 4DATE:
12/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jason and Magdarline WinbladTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an announced Pre-Licensing visit. LPA was met by Applicants Jason Winblad and Magdarline Winblad and was granted entry into the facility. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 11/03/2021, and the facility was approved for 4 non-ambulatory clients, 1 bedridden client, and 1 ambulatory client.

During today's visit, LPA toured the facility, observed 4 clients in care, and inspected every room. The facility was found to be clean and in good repair with no pathway obstructions. Clients' bathrooms were observed to be clean and the toilets were found to be in working order. The facility's water temperature in the client bathrooms was measured at 107.4, 109.8 and 111.6 degrees Fahrenheit respectively. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage area for clients medications. A fire extinguisher was observed in the facility and found to be in compliance. Functioning carbon monoxide and smoke detectors was also observed in the facility. No bodies of water were observed near or on the premises. LPA observed 7 day supply of non-perishable food and 2 day supply of perishable food. Required postings were observed in a common area in the facility.

LPA conducted Component III with the applicants. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance.

Pre-Licensing is complete and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted, and a copy of this report was provided to Applicants Jason Winblad and Magdarline Winblad via email.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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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