361880660-12-28-2022-56-AS-NBRN-CMJUDC-20221228142918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 12/28/2022
Date Signed: 12/28/2022 08:23:02 AM

Unfounded

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
12/19/2022 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 56-AS-20221219095004

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:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Tae Kim, Administrator		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff did not safeguard resident's personal belonging(s).

INVESTIGATION FINDINGS:

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Amy Goldenberg, Licensing Program Analyst (LPA), is conducting this unannounced 10 day visit to investigate the above-mentioned complaint allegation. It is alleged that facility staff removed the personal property, a side table, from R1's bedroom. Investigation consisted of interview of R1. R1 indicated that they informed facility staff that the item that staff was attempting to remove belonged to them and R1 indicated to LPA that staff did not remove that item from their room upon learning that it was a personal piece of furniture and not property of the facility. Based on the information received during the interview of R1, LPA has determined that no personal property was removed by staff from the bedroom of R1 as alleged. We have found the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed with, and furnished to the facility representative.

Unfounded

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: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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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