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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800003
Report Date: 08/09/2025
Date Signed: 08/09/2025 03:16:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2022 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 18-AS-20220422170007
FACILITY NAME:AZZUR ASSISTED LIVING LLCFACILITY NUMBER:
331800003
ADMINISTRATOR:RADWAN BYRON GONZALOFACILITY TYPE:
740
ADDRESS:397 E MAIN STREETTELEPHONE:
(951) 665-6240
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:0CENSUS: 0DATE:
08/09/2025
UNANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Liberty Almazan - AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff failed to seek timely medical attention
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with former Administrator Liberty Almazan and explained the reason for the visit. LPA attempted to contact the former operator Maryjane Tolentino but did not respond to LPA's call.

LPA conducted a physical plant tour at 8:30 AM, reviewed records between 9:00 AM to 10:00 AM and interviewed the former Administrator at 10:10 AM. Regarding the allegation that the Facility staff failed to seek timely medical attention, it was alleged that Resident #1 (R1) had a fall and bumped R1's head and the staff only called 911 days later. During this visit, LPA did not have any documents or files to review as this facility has been closed since 04/17/23 and no resident or staff file left at the facility. LPA attempted to call the former licensee to no avail. LPA Janira Arreola's interview with the former licensee on 10/18/24 revealed that R1 was on Hospice services at the time of the fall incident. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20220422170007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AZZUR ASSISTED LIVING LLC
FACILITY NUMBER: 331800003
VISIT DATE: 08/09/2025
NARRATIVE
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(continued from LIC 9099)

The Licensee called the Hospice agency for advice regarding the fall but did not get a timely response until staff noticed something medically unusual regarding R1 days later which prompted the facility to call 911.

Absent medical documentation directly linking R1's fall to cause R1's medical condition upon hospitalization and no direct witness to the fall incident, a correlation between the fall and the cause for hospitalization could not be established.

Based on the information gathered during this and prior visit, this allegation is deemed unsubstantiated at this time.

The allegation may have happened or is valid but there is not a preponderance of evidence to prove that violation occurred.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2