361880660-2-16-2022-18-AS-NBRN-CCAQNR-20220307111933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 02/13/2022
Date Signed: 02/16/2022 11:29:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/10/2022 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220210094410

FACILITY NAME:	RIALTO ASSISTED LIVING		FACILITY NUMBER:	361880660
ADMINISTRATOR:	KYONG SUK LEE		FACILITY TYPE:	740
ADDRESS:	1441 S RIVERSIDE AVE		TELEPHONE:	(909) 877-2340
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	94	CENSUS: 47	DATE:	02/13/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kyong (Clara) Suk Lee, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff speaks inappropriately to resident.

INVESTIGATION FINDINGS:

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On 2/16/21, Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of investigating the above allegation. The LPA met with administrator Kyong (Clara) Suk Lee, explained the nature of the visit and was granted entry.

The investigation, which consisted of file reviews and interviews revealed the following:
Resident 1 (R1) reported that on 2/9/22, they pressed the call button for assistance.
Staff 1 (S1) and Staff 2 (S2) responded to the call. R1 denied that S1 spoke inappropriately to them while providing assistance. R1 denied that S2 spoke inappropriately to while them providing assistance.
***Continued on 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

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-20220210094410

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/13/2022

NARRATIVE

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***Continued from 9099***

S1 and S2 entered the room and R1 was on the phone with family. S1 asked R1 if they could put down the phone so that they could assist. R1's family member began asking S1 questions while on speakerphone. S1 responded to the family member and used a higher than normal tone due to being on speakerphone. Interviews with S1 and S2 revealed the only thing that S1 said to R1 while they were in the room was if R1 could put the phone down and that was said in a normal tone. S1 an denied speaking inappropriately to R1. S2 denied that S1 spoke inappropriately to R1. Staff 3 (S3) and Staff 4 (4) and reported that S1 is a very good caregiver and does not speak inappropriately to residents. Residents 2 (R), Resident 3 (R3) and Resident 4 (R4) reported that they have never experienced being spoken to inappropriately to by S1 nor have they witnessed S1 speaking inappropriately to other residents. During an interview with the administrator, it was reported that she has never received complaints about S1 speaking inappropriately to residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time. An exit interview was conducted where this report and LIC 811 were provided to administrator Kyong (Clara) Suk Lee.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

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