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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800003
Report Date: 03/28/2023
Date Signed: 03/28/2023 11:52:47 AM


Document Has Been Signed on 03/28/2023 11:52 AM - 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: 20DATE:
03/28/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Mary Jane TolentinoTIME COMPLETED:
12:00 PM
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An Informal Meeting was conducted today 3/28/2023 at 10:00 am via Microsoft Teams. Persons present at today’s meeting were: Licensing Program Analysts (LPAs) Janira Arreola and Janette Romero, along with Licensing Program Manager (LPM) Joel Esquivel, and Regional Manager (RM) Reyna Lacey. In addition, Licensee Mary Jane Tolentino and home owner Marilou Camaliuan were also in attendance.

Below are the topics that were addressed:
  • Eviction notice that was provided to the licensee by homeowner.
  • Change of location: Licensee was informed to submit an application
  • Issue eviction notices to all residents and send copies to CCL staff as soon as possible
  • Provide an outcome of the licensee's discussion with their attorney


An exit interview was conducted over the phone and a copy of this report was provided via email to Administrator Mary Jane Tolentino for signature.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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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