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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800003
Report Date: 04/17/2023
Date Signed: 04/17/2023 05:21:46 PM


Document Has Been Signed on 04/17/2023 05:21 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: 0DATE:
04/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Mary Jane Tolentino, LicenseeTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit for the purpose of the facility's Licensee initiated closure.

On March 22, 2023 the department was notified that the Licensee was given a 30 day eviction notice. It was also reported that the property owner Mary Lou Tumalian had lost control of the property. The facility's relocation plan was submitted to the department, and the projected closure date and to have all of the residents relocated was April 15, 2023.

LPA conducted a tour of the interior and exterior of the facility. LPA observed for there not to be any residents residing in the facility. There were no personal belongings or food observed, to serve to anyone. There were not any medications or cleaning supplies observed. The beds were stripped and some mattresses were outside. The trash dumpster was full of items to be discarded. The effective date of closure is April 15, 2023. In addition, LPA observed tools, several construction crew members working around the property, that were getting measurements and reviewing the facility sketch.

Licensee Mary Jane also provided a copy of the facility license to LPA, stating that they were not provided with an original.

An exit interview was conducted where a copy of this report was discussed with and provided to Licensee Mary Jane Tolentino.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023
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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