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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800003
Report Date: 11/21/2022
Date Signed: 11/21/2022 12:34:56 PM


Document Has Been Signed on 11/21/2022 12:34 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:AZZUR ASSISTED LIVING LLCFACILITY NUMBER:
331800003
ADMINISTRATOR:LIBERTY ALMAZANFACILITY TYPE:
740
ADDRESS:397 E MAIN STREETTELEPHONE:
(951) 665-6240
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:24CENSUS: 22DATE:
11/21/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Liberty Almazan, AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Yolanda Delgado conducted an unannounced Case Management-Health Check due to a notation about residents on incontinence care. There are four (4) staff working out of a total of ten (10) staff and twenty-two (22) residents were observed with no immediate concern. There is working utilities at the facility, non-perishable and perishable foods in stock for residents. LPA Delgado toured the facility and interviewed ten (10) residents and the remaining residents were interviewed due to being lunch time and were eating their meals.

An exit interview was conducted with Liberty Almazan were this report was reviewed with and provided to Liberty.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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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