Avalon Care Home II

Type of visit: Case Management - Incident

On 08/18/2026 Licensing Program Analyst (LPA) Star Stevenson arrived unannounced on a Case Management visit as a result of an incident/allegation that licensee indicates was first reported 08/14/2026 and then self-reported by the licensee of Avalon Care Home II to Community Care Licensing on the afternoon of 08/17/2026. A Type B violation of CCR 87211(c) Reporting Requirements for failure of timely reporting is being cited (see 809-D page) LPA made observations and obtained documents. Report was reviewed with licensee Pritpal Atwal whose signature denotes receipt. Appeal rights were given.the state’s words, verbatim · CDSS document, Aug 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87211 · Plan of correction due date: Aug 28, 2026

87211 Reporting Requirements (c) Each licensee shall furnish to... licensing...reports of...all instances of known...or alleged abuse of an elder dependent...shall be reported to...long-term care ombudsman, the local law enforcement agency, and... licensing agency. This regulation is not met as evidence by: Licensee learned of alleged elder abuse on 08/14/2026 and did not begin required notifications until 08/17/2026the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: Licensee to review General licensing requirements of HSC 87211, as well as, the specific requirements of 87211(c), as well as review the requirements of a "Mandated Reporter" and review the requirements when filling out an SOC341 and conduct training with staff on the requirements of a "mandated reporter" and to attest by 08/28/2026 that the above has been review with staff.

Type of visit: Case Management - Annual Continuation

At approximately 12:30 PM Licensing Program Analyst (LPA) Star Stevenson arrived to CONTINUE a required 1 year annual inspection and was greeted by caregiver Florencia Rivera who called Licensee/Administrator Pritpal Atwal who arrived at approximately 12:50 PM. Facilities side gate was observed to be open and an employee on premises indicated the wind will blow open that gate at times. The gate is observed to have two (latches) and a lower latch can be used to fully secure the gate while allowing access for emergency services and licensee was advised to ensure that all staff are using at least the lower latch to ensure gate remains closed at all times. Facility conducts regular quarterly disaster drills, and the most recent drill was conducted April 2026. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA reviewed facility's emergency disaster plan last updated 05/2026. At approximately 12:30 PM, four (4) staff files and four (4) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial and annual training hours. All residents have updated LIC602's and Appraisal Service and Needs plans. At approximately 1:45 PM medicines were found to be centrally stored and secured and their administration observed to be accurate. Licensee/Administrator states residents' families coordinate their medical and dental appointments as needed and provide their own transportation to and from these visits. Continued on LIC809C Continued from LIC809 LPA requested the following updated forms to be submitted to Community Care Licensing by 07/22/2026: Any new LIC 308 Designation of Facility Responsibility (1 person per form) LIC 500 Personnel Report LIC 9020 Facility Register of Client/Residents (2 new residents) Copy Liability Insurance when renewed in July 2026 LIC 610E Emergency Disaster Plan (updated) No Deficiencies are cited today. Exit interview conducted with Licensee whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Jun 23, 2026

Type of visit: Required - 1 Year

At approximately 11:35 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-Year visit and met with Licensee/Administrator Pritpal Atwal, LPA was informed there are five (5) residents in care, one (1) of which is on Hospice. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for six (6) residents an approved dementia plan and fire clearance for capacity of six (6) non-ambulatory residents. At approximately 11:50 AM, LPA initiated a tour of the facility and observed the following: Facility is a two-story home, was a comfortable temperature, and passageways were free from obstructions. The second floor was observed gated off from resident access, and LPA was informed that the upstairs loft, closet and bathroom are staff living quarters or storage. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Laundry and cleaning chemicals in the laundry area were observed to be locked. Facility has at least two days of perishable foods and a supply of non-perishable foods. LPA observed fresh fruits and snacks set out for residents. Licensee/Administrator informed LPA that activities change according to the needs and wants of the residents in care. Currently, those involve individualized exercises, knitting, puzzles and reading. Continued on LIC809C Continued from LIC809 Facility purchases a new charged fire extinguisher each year, with the most recent one purchased June 2026. Smoke and Carbon Monoxide detectors were tested and operational during inspection. LPA will return at a later unannounced date to complete annual required inspection and will request documents to update the facility file at that time. No deficiencies citedthe state’s words, verbatim · CDSS document, Jun 19, 2026

Type of visit: Case Management - Annual Continuation

At approximately 11:40 AM Licensing Program Analyst (LPA) Star Stevenson arrived to CONTINUE a required 1 year annual inspection and was greeted by caregiver Florencia Rivera who called Licensee/Administrator Pritpal Atwal who arrived at approximately 12:15 PM. Facility continues to care for six (6) residents, three (3) of which are on hospice. Facility conducts regular quarterly disaster drills, and the most recent drill was conducted May 2025. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA reviewed facility's emergency disaster plan last updated 07/2024. At approximately 12:30 PM, three (3) staff files and five (5) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial and annual training hours. LPA reviewed five (5) of six (6) resident files which contained all required documentation including negative TB and/or negative chest X-ray for active disease. Licensee/Administrator states residents' families coordinate their medical and dental appointments as needed and provide their own transportation to and from these visits. LPA reviewed medications which were observed to be locked and medication records were observed to be maintained in compliance with regulation. Facility does not maintain P&I monies for residents and Community Care Licensing Department (CCLD) has a signed Affidavit (LIC400) on file. LPA requested the following updated forms to be submitted to Community Care Licensing by 08/11/2025: -Any NEW LIC 308 Designation of Facility Responsibility (1 person per form) - LIC 500 Personnel Report - Copy of current valid and non-expired Liability Insurance - LIC 9020 Facility Register of Client/Residents - LIC 610E Emergency Disaster Plan (updated) No Deficiencies are cited today. Exit interview conducted with Licensee whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Jul 11, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 1:00 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-Year visit and met with Licensee/Administrator Pritpal Atwal, LPA was informed there are six (6) residents in care, three (3) of which is on Hospice. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver the was recently increased from three (3) to six(6), an approved dementia plan and fire clearance for capacity of six (6) non-ambulatory residents. At approximately 1:15 PM, LPA initiated a tour of the facility and observed the following: Facility is a two-story home, was a comfortable temperature, and passageways were free from obstructions. The second floor was observed gated off from resident access, and LPA was informed that the upstairs loft, closet and bathroom are staff living quarters. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Laundry and cleaning chemicals in the laundry area were observed to be locked. Facility has at least two days of perishable foods and a supply of non-perishable foods. Licensee/Administrator informed LPA that activities change according to the needs and wants of the residents in care. Currently, those involve individualized exercises, knitting, and reading. Facility purchases a new charged fire extinguisher each year, with the most recent one purchased June 2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on LIC809C Continued from LIC 809... LPA requested no documents today Do deficiencies cited today Exit interview conducted with Licensee whose signature on this document confirms receipt. This report was reviewed with Licensee and Appeal Rights were given.the state’s words, verbatim · CDSS document, Jul 3, 2025

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

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.the state’s words, verbatim · CDSS document, Jul 2, 2024

Type of visit: Required - 1 Year

***Amended LIC809-D due to technical difficulties on 6/27/2024. At approximately 9:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and met with Pritpal Atwal, Licensee/Administrator. LPA was informed there are four (4) residents in care, one (1) of which is on Hospice. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for three (3), an approved dementia plan and fire clearance for capacity of six (6) non ambulatory residents. At approximately 9:15 AM, LPA initiated a tour of the facility and observed the following: Facility is a two-story home, was a comfortable temperature, and passageways were free from obstructions. The second floor was observed gated off from resident access, and LPA was informed that the upstairs loft, closet and bathroom are staff living quarters. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. LPA observed some laundry and cleaning chemicals in the laundry area and garage which were not readily accessible to residents in care, but LPA advised, and Licensee/Administrator agreed to place the observed chemicals and laundry detergents in the cabinet above the washer and dryer and install a lock on the cabinet which will remain locked. Facility has at least two days of perishable foods and a supply of non-perishable foods, which LPA advised Licensee/Administrator to increase to sufficiently sustain all residents in care for a week if needed. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed books, and a couple games and puzzles for client activities. Licensee/Administrator informed LPA that activities change according to the needs and wants of the residents in care. Currently, those involve individualized exercises, knitting, and reading. Facility purchases a new charged fire extinguisher each year, with the most recent one purchased June 2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on 809-C... Continued from LIC 809... Facility conducts regular quarterly disaster drills, and the most recent drill was conducted April 2024. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA advised Licensee/Administrator to increase the facility's emergency water supply to sustain all the residents in care for one week if needed. LPA reviewed facility's emergency disaster plan last updated 11/2020. At approximately 10:30 AM, three (3) staff files and four (4) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial and annual training hours. LPA observed 1 of 3 staff do not have the required LIC501 - Job application. LPA observed all the remaining required documentation in 3 of 3 staff files reviewed. LPA reviewed 4 of 4 resident files and observed 1 of 4 resident files missing proof of negative TB results. LPA observed that 4 of 4 client files had all the remaining required documentation per regulation. Licensee/Administrator states residents' families coordinate their medical and dental appointments as needed and provide their own transportation to and from these visits. LPA reviewed medications and medication records which are maintained in compliance with regulation. Facility does not maintain P&I monies for residents and CCLD has a signed Affidavit (LIC400) on file. LPA requested the following updated forms to be submitted to Community Care Licensing by 07/27/2024: - LIC 308 Designation of Facility Responsibility (1 person per form) - LIC 500 Personnel Report - Copy of Liability Insurance - LIC 9020 Facility Register of Client/Residents - LIC 610E Emergency Disaster Plan (updated) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Licensee whose signature on this document confirms receipt. This report was reviewed with Licensee and Appeal Rights were given.the state’s words, verbatim · CDSS document, Jun 27, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.