331800003-8-9-2025-18-AS-RORN-DLLTRY-20250917145821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800003
Report Date: 08/09/2025
Date Signed: 08/09/2025 03:26:01 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
03/16/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 18-AS-20230316115232

FACILITY NAME:	AZZUR ASSISTED LIVING LLC		FACILITY NUMBER:	331800003
ADMINISTRATOR:	LIBERTY ALMAZAN		FACILITY TYPE:	740
ADDRESS:	397 E MAIN STREET		TELEPHONE:	(951) 665-6240
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY:	0	CENSUS: 0	DATE:	08/09/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Liberty Almazan - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is understaffed to meet the needs of the residents in care

Facility staff are not assisting resident with their activities of daily living

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 1:00 PM, reviewed records between 1:15 PM to 1:45 PM and interviewed the former Administrator at 2:00 PM. Regarding the allegation Facility is understaffed to meet the needs of the residents in care, it was alleged that the facility is understaffed and there are not enough employees to take care of all the individuals who live at the facility. 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.

(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)

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Control Number 18-AS-20230316115232

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)

LPA's interview with the administrator at around 2:00 PM revealed that during the time of this complaint (March 2023) there were approximately sixteen (16) residents left. The staffing level was at two (2) care staff during AM shift (7:00 AM to 3:00 PM), two (2) care staff during PM shift (3:00 PM to 11:00 PM) and one (1) staff during NOC shift (11:00 PM to 7:00 PM) there are however no more residents or staff to interview at this time to confirm or negate the allegations.

Regarding the allegation that Facility staff are not assisting residents with their activities of daily living, it was alleged that there were no staff at the facility to assist R1 to walk around and need help out of bed. LPA's interview with the administrator at around 2:00 PM revealed that during the time of this complaint (March 2023) there were approximately sixteen (16) residents left. The staffing level was at two (2) care staff during AM shift (7:00 AM to 3:00 PM), two (2) care staff during PM shift (3:00 PM to 11:00 PM) and one (1) staff during NOC shift (11:00 PM to 7:00 PM) there are however no more residents or staff to interview at this time to confirm or negate the allegations. Further interview also revealed that R1 was semi-independent and mostly able to do own Activities of Daily Living but only scared to do so due to R1's prior experience.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

These allegations may have happened or are 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)

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