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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880660
Report Date: 07/02/2021
Date Signed: 07/02/2021 04:11:12 PM

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:RIALTO ASSISTED LIVINGFACILITY NUMBER:
361880660
ADMINISTRATOR:KYONG SUK LEEFACILITY TYPE:
740
ADDRESS:1441 S RIVERSIDE AVETELEPHONE:
(909) 877-2340
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:94CENSUS: 47DATE:
07/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tae Kim - Assistant AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of investigating recent concerns received regarding facility operations. LPA Colvin met with Assistant Administrator Tae Kim and advised him of the purpose of the visit. Below is a summary of items discussed/addressed:

Bed Bugs - Issue currently resolved according to Assistant Administrator Tae Kim

Roommate Issues/ Smoking in Rooms - Issue resolved according to staff.

Sale of Postal Stamps - Title 22 Regulations discussed and Tae Kim was informed on how to comply with the Regulations in this regard. A Technical Violation is being issued to the facility in lieu of a deficiency.

Broken Laundry Machine - LPA Colvin confirmed that one of the two facility's washing machines is broken, and the facility is not expecting to have a repairman be able to come out until 7/8/21. Staff accounts vary on the date that the washing machine broke down. LPA Colvin reviewed the Maintenance Log and observed notes on 6/16/21, 6/24/21, 6/29/21, and 6/30/21 regarding the washing machine not working and calling various persons to investigate getting it repaired. While the facility does still have one operating washing machine, the housekeeping staff is having to prioritize which articles to wash first, and hold off on other items (such as blankets and comforters) in order to ensure that towels and sheets are kept clean and available to change for residents. The facility has not taken additional measures to ensure that there is adequate equipment available for the washing of resident's clothing and other necessary items (towels, sheets, blankets).Deficiency cited. During today's visit, LPA Colvin was additionally informed by Assistant Administrator Tae Kim that the Administrator (Kyong "Clara" Suk Lee) is currently on medical leave and Tae will be filling in as Assistant Administrator in the meantime.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
VISIT DATE: 07/02/2021
NARRATIVE
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The facility was cited a deficiency which is detailed on the LIC809D. A copy of this report, LIC809D, LIC9102TV, and appeal rights were provided to Assistance Administrator Tae Kim during the exit interview.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2021
Section Cited

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Maintenance and Operation: (g) Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair.... This requirement was not met by:
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Based on interviews and record review, the Licensee did not comply with the above regulation with 1 of 2 washing machines. LPA Colvin observed that 1 of the 2 facility washing machines has been out of order since 6/16/21 and will not be fixed until at least 7/8/21. This is a potential personal rights and health risk.
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3