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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 02:36:53 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
12/14/2022 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221214135139
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:
11:16 AM
MET WITH:TIME COMPLETED:
11:17 AM
ALLEGATION(S):
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Staff do not ensure that residents are adequately fed
Staff mismanaged resident medications
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 allegations, “Staff do not ensure that residents are adequately fed” it was alleged the facility does not follow a menu and residents are served minimal portions. Two (2) staff were interviewed and reported the following information. The facility had a menu available for Community Care Licensing staff's review only, but the menu was never followed. The residents were consistently served only one item such as one (1) hot dog, ramen noodles, or a “sandwich” made up of two (2) pieces of white bread with a thin slice of bologna. The facility failed to add fruits, vegetables, or condiments to complete the meal. Requests for nutritious foods and complete meals for the residents were frequently made to Administrator Almazan and always ignored. The facility provided minimal food portions to the residents due to refusing to spend money on food.
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-20221214135139
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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As a result, several residents often expressed they were still hungry after meals and residents were denied more food. On several occasions, both staff used their personal money to purchase additional food, snacks, and drinks for the residents and were never reimbursed by the facility. However, this act was not always financially possible for staff and residents continued complaining they were still hungry after meals. One (1) of two (2) staff interviewed reported during one (1) occasion they were about to serve milk to the residents and detected a rancid smell coming from the cup. Administrator Almazan directed staff to continue serving the possibly spoiled milk to residents to which the staff refused to comply. The facility has yet to submit written information of the food purchased for the residents to assess whether the facility met the food service requirements.

Regarding the allegation, “Staff mismanaged resident medications” it was alleged several residents do not have their medications. Two (2) staff were interviewed and reported witnessing several residents 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 multiple residents missing their medications for a week or more until the refills were received.

One (1) additional staff declined to be interviewed, and LPA made several unsuccessful attempts to make contact with Licensee Tolentino and Administrator Almazan. 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 12, Chapter 1), are being cited on the attached LIC 9099 D. Due to the facility's closure and the licensee and administrator being unresponsive, LPA was unable to conduct an exit interview and a copy of this report, LIC 9099-D, Appeal Rights, 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-20221214135139
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
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 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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Type B
05/14/2025
Section Cited
CCR
87555(a)
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87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. 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 provide sufficient food for the residents in care resulting in staff using their own money purchase additional food for the residents without being reimbursed. This poses a potential health, safety, and personal rights 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