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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800003
Report Date: 05/14/2025
Date Signed: 05/14/2025 01:39:05 PM

Substantiated


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
11/15/2022 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221115163004
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:0CENSUS: 0DATE:
05/14/2025
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:TIME COMPLETED:
01:36 PM
ALLEGATION(S):
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Facility staff are retaliating against resident for making complaints.
Medications not being given as prescribed by physician.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) made several unsuccessful attempts to contact Licensee, Mary Jane Tolentino and Administrator, Liberty Almazan to deliver findings regarding the allegations listed above. Departmental records indicate the facility has been closed since 4/17/2023. At this time, licensee and administrator have been unresponsive.

Regarding the allegation, “Facility staff are retaliating against resident for making complaints” it was alleged the facility retaliated against Resident 1 (R1) for complaining against the facility due to lack of care. R1 is listed as resident in the October 2022 resident roster received by the Department. However, the facility failed to provide the Department with a copy of R1’s resident records. As a result, LPA was unable to locate R1’s whereabouts or contact information to conduct an interview. One (1) of two (2) staff interviewed reported R1 was cognizant and frequently complained about the facility, which Administrator Almazan disliked. One (1) of two (2) staff interviewed reported being present when Administrator Almazan posted a notice prohibiting staff from providing R1 with the television remote as a form of retaliation. One (1) of two (2) staff interviewed reported observing other staff remove the notice every time Community Care Licensing (CCL) or other agencies visited the facility to avoid CCL and other agencies from seeing the notice. LPA reviewed a notice dated 9/16/2022 stating in part, “The TV remote control will be kept in the office. Anyone who operates the TV should not hand or give the remote to [R1]. Let [R1] call ombudsman or licensing”.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
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 3
Control Number 18-AS-20221115163004
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: 05/14/2025
NARRATIVE
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Regarding the allegation, “Medications not being given as prescribed by physician” it was alleged R1 had issues obtaining their medication. Two (2) staff were interviewed and reported witnessing several residents, including R1, miss their prescribed medications because Administrator Almazan failed to order medication refills timely. Both staff reported notifying Administrator Almazan a week before a resident’s medication was depleted and asking management to order a refill, but requests were often ignored. This resulted in residents missing their prescribed medications for a week or more until the medication refills were provided.

One (1) additional staff declined to be interviewed, and LPA made several unsuccessful attempts to make contact with Licensee Tolentino and Administrator Almazan for an interview. Based on all available information, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. Due to the facility's closure and the facility being unresponsive, LPA was unable to conduct an exit interview and a copy of this report, LIC 9099 D and Confidential Names list (LIC 811) will be mailed to the facility’s mailing address on file.

SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20221115163004
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by:
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The facility has been closed since 4/17/2023 and licensee/administrator have not been responsive to generate a plan of correction.
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Based on record review and interviews conducted, the facility posted a notice prohibiting staff from providing R1 with the television remote as a form of retaliation. This posed potential personal rights risk to residents in care.
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Type B
05/14/2025
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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The facility has been closed since 4/17/2023 and licensee/administrator have not been responsive to generate a plan of correction.
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Based on interviews conducted, the facility failed to order resident medication refills timely resulting in several residents, including R1, missing their prescribed medications for a week or more until the refills were provided. This posed a potential health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3