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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880660
Report Date: 07/13/2022
Date Signed: 07/13/2022 12:42:56 PM


Document Has Been Signed on 07/13/2022 12:42 PM - It Cannot Be Edited

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
, 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: 45DATE:
07/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Kyong Suk Lee, Administrator TIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA’s) Rayshaun Nickolas and Javier Prieto made an unannounced visit to the facility. The LPA’s Nickolas and Prieto arrived at the facility to conduct a case management visit to follow up on a special incident report (SIR) that was received on July 6, 2022. LPAs met with Administrator Kyong Suk Lee and explained the purpose of the visit.

The SIR documents a client observing another client inappropriately touching another client in the living room and reporting this incident to staff. The SIR documents facility staff reviewed video footage taken from the surveillance camera in the living room and the facility staff reports no inappropriate touching was captured. The SIR further documents that the police were contacted, and no arrests were made. During the visit LPAs reviewed the video captured by the surveillance camera in the living room, obtained the police report number, and interview the Administrator. LPAs advised the Administrator to ensure that the facility staff are observing and monitoring for any changes in clients condition, properly documenting changes in clients condition, adequately staffed to provide proper care and supervision of clients in care, and submitting SIR’s to Community Care Licensing Division (CCLD) with detailed documentation.

No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to the Administrator



SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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