331800003-5-29-2026-18-AS-APEZ-DUK2B7-20260529171438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800003
Report Date: 05/29/2026
Date Signed: 05/29/2026 04:17:00 PM

Unsubstantiated

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
07/19/2021 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210719082700

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:	05/29/2026
		UNANNOUNCED	TIME BEGAN:	03:58 PM
MET WITH:	Unable to meet/Facility closed since 7-13-2023		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Questionable death.
Authorized representative was not notified of resident's health change.
Facility did not provide resident with modified diet.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yolanda Delgado mailed this report to the ex-licensee’s last known mailing address via USPS certified mail to communicate the findings related to the above-mentioned allegation. The facility has been closed since April 17, 2023.

On July 19, 2021, Community Care Licensing received a complaint alleging Questionable death, Authorized representative was not notified of resident’s health change, and Facility did not provide resident with modified diet.

LPA obtained copies of the following documents for Resident #1 (R1)’s Identification and Emergency information dated 3/18/2021, physician report dated 2/10/2020, appraisal dated 6/2/2017, appraisal/needs and services plan, medication list, facility care notes, hospice emergency plan dated 10/17/2020, hospice admission agreement, hospice medication list and Death report dated 7/12/2021, mortuary documents, certificate of Death. Additional interviews with Licensee were attempted but not successful. (Continued on Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

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-20210719082700

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: 05/29/2026

NARRATIVE

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(Continued from Page 1)

In regard to the allegation Questionable death, it is alleged that death from possible heart issue that was not known. The Department interviewed witnesses and facility staff, reviewed R1’s physician report, appraisal, appraisal/needs and services plan and it was revealed R1 had a history of mental health, COPD, non-insulin diabetic with blood sugar monitoring checks, fall risk due to balance issues, required assistance with showering and grooming, NIDDM, arthritis, schizoaffective and Certificate of Death obtained stated immediate Cause of Death was Atheroscierotic Cardiovascular disease. Interviews conducted and documents reviewed did not corroborate the allegation of questionable death and no concerns regarding the care of R1 was receiving prior to the time of death. LPA was unable to contact Licensee, and additional Staff to corroborate the allegation even though attempts were not successful.

In regard to the allegation Authorized representative was not notified of resident’s health change, it is alleged that R1’s Authorized representative was not informed of R1’s changes in condition and death in a timely manner. The Department conducted interviews with witnesses and staff, reviewed R1’s Identification and emergency information, admission agreement, appraisal/needs services plan, hospice admission agreement, death report and it was revealed R1 was not conserved, limited assistance with Activity of Daily living and was able to advocate for self, R1 had additional person as an emergency contact. Interview with R1’s sister confirmed that text messages were received by Licensee regarding R1. Staff were in communication with R1’s emergency contact as needed as R1 did not want to always talk to the sister on the telephone. Staff and hospice notified of R1’s death in a sufficient time frame. Interviews conducted and documents reviewed did not corroborate the allegation of Authorized representative was not notified of resident’s health change. LPA was unable to contact Licensee, and additional Staff to corroborate the allegation even though attempts were not successful.

(Continued on Page 3)

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210719082700

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: 05/29/2026

NARRATIVE

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(Continued from Page 2)

In regard to the allegation Facility did not provide resident with modified diet, it is alleged that R1 was not given a diabetic diet. The department conducted interviews with staff, reviewed R1’s physician report, hospice medication/DME list and there was no physician order for a special diet observed for R1. Facility staff provided meals, snacks to R1, R1 was able to advocate for self and choose the meals and snacks that were consumed and R1 was not on a special diet. Interviews conducted and documents reviewed did not corroborate the allegation Facility did not provide resident with modified diet. LPA was unable to contact Licensee, and additional Staff to corroborate the allegation even though attempts were not successful.

Based on interviews and documents reviewed, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was not conducted as the facility has been closed since April 17, 2023. A copy of this report was sent to the ex-licensee’s last known address via USPS certified mail, due to the facility closure.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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