361880660-6-2-2022-56-AS-NBRN-CF9QFW-20220610120838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 06/02/2022
Date Signed: 06/02/2022 03:51:15 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/24/2022 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220524084823

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: 45	DATE:	06/02/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Clara Suk Lee, Administrator.		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident's fees were increased without proper notice.

INVESTIGATION FINDINGS:

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This unannounced visit is being conducted by Amy Goldenberg, Licensing Program Analyst (LPA), to initiate the 10 day visit to investigate the above-mentioned complaint allegation.

During the course of this investigation visit LPA interviewed the facility administrator, interviewed resident R1, reviewed R1s facility file, and requested a copy of the facility's rate increase policy. Investigation revealed the following: R1 reports that they had a rate increase and did not receive a written notice. Staff interviewed report that a notification letter is provided for rate changed at the end of the prior year. According to the facility administrator the letter was sent out November 29th, 2021 to all of the residents which were impacted by govermental changes in Social Security rates.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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 56-AS-20220524084823

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
, CA 92507

FACILITY NAME: RIALTO ASSISTED LIVING	FACILITY NUMBER: 361880660
	VISIT DATE: 06/02/2022

NARRATIVE

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In addition to Social Security R1 reports that they are receiving disability benefits and according to documentation provided by the facility to R1 indicates they are responsible for an additional $20.00 monthly charge. Based on conflicting information regarding the allegation of resident's fees were increased without proper notice, we have found the allegation to be unsubstantiated. Although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC9099 (FAS) - (06/04)

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