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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803392
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:11:42 PM


Document Has Been Signed on 07/02/2024 02:11 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:AVALON CARE HOME IIFACILITY NUMBER:
486803392
ADMINISTRATOR:ATWAL, PRITPAL K.FACILITY TYPE:
740
ADDRESS:5082 RASMUSSEN WAYTELEPHONE:
(707) 386-1042
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: DATE:
07/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Pritpal Atwal, Licensee/AdministratorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct this Case Management Visit to amend a report originally dated 06/27/2024. LPA met with Pritpal Atwal, Licensee/Administrator.

On June 27, 2024 LPA issued a citation missing POC language due to technical difficulties. LPA has returned to amend (LIC809 and LIC809Ds) and add POC language to the citation.

No citations were issued during this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie FlorioTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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