331800003-8-27-2024-18-AS-KCLS-D8KMFP-20240828093442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800003
Report Date: 08/27/2024
Date Signed: 08/27/2024 10:59:00 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/14/2020 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200914151314

FACILITY NAME:	AZZUR ASSISTED LIVING LLC		FACILITY NUMBER:	331800003
ADMINISTRATOR:	RADWAN BYRON GONZALO		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:	08/27/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator not available		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility air conditioning is broken.
Facility has a bed bug infestation.
Facility is not serving food of the quality or quantity necessary to meet the residents' needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto concluded the complaint investigation regarding the above allegations. Regarding the allegation that facility air conditioning is broken, LPA was not able to address the facility air conditioning unit as the facility has been closed as of April 17, 2023.

Regarding the allegation that the facility has a bed bug infestation LPA was not able to address the facility for a bug infestation has been closed as of April 17, 2023.

Regarding the allegation that facility is not serving food of the quality or quantity necessary to meet the residents' needs, LPA was not able to address the facility for or residents relating to food quality and quantity as the facility has been closed as of April 17, 2023.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024

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-20200914151314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 LLC	FACILITY NUMBER: 331800003
	VISIT DATE: 08/27/2024

NARRATIVE

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LPA Prieto made several attempts to contact the licensee telephonically with no response. The facility has been closed as of April 17^th, 2023 and unable to communicate with the facility Administrator to discuss this the elements of conclusion of the complaint and its conclusion. There were no witnesses, or residents available to interview.

Based on the information obtained there is not enough evidence that facility air conditioning is broken, facility has a bed bug infestation and facility is not serving food of the quality or quantity necessary to meet the residents' needs, therefore the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto. Facility representative was not available for signature.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

LIC9099 (FAS) - (06/04)

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