361880660-9-19-2022-56-AS-EMAN-CKHSRS-20221024140650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 09/19/2022
Date Signed: 09/19/2022 03:10:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
09/12/2022 and conducted by Evaluator Natalie Ibarra

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220912140939

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:	DATE:	09/19/2022
		UNANNOUNCED	TIME BEGAN:	12:39 PM
MET WITH:	Tae Kim		TIME COMPLETED:	03:19 PM

ALLEGATION(S):

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Staff did not safeguard residents belonging.
Staff threaten resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Ibarra conducted an unannounced visit to the facility to conduct an investigation for the above allegations. LPA met with administrator Tae Kim and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties and records review.

The first allegation indicates staff did not safeguard residents belonging. Interviews with Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), and Staff #4 (S4) stated Resident #1 (R1) had informed the new administrator that their Playstation 3 (PS3) was broken by staff, but that R1 was not able to provide date nor by whom PS3 was broken by. S4 stated R1 had mentioned to the prior administrator that their PS3 was broken and was told by the prior administrator that they would look into it. Interview with R1 stated that one day they were trying to play their PS3 and noticed it wasnt working. When inspecting it, R1 noticed it was cracked and they notified the prior adminsitrator who stated they would look into it. R1 does not know how their PS3 came to have a crack nor did they state that a staff member dropped it. R3 also stated the facility did not state they would replace it but instead that he informed the prior administrator that he wanted it replaced.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

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-20220912140939

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RIALTO ASSISTED LIVING	FACILITY NUMBER: 361880660
	VISIT DATE: 09/19/2022

NARRATIVE

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The second allegation indicated that staff threatened resident in care. Interviews with S2 and S3 stated they did not witness S1 swing nor threaten R1 on 9/1/2022. S1, S2, and S3 stated R1 got angry and started making threatening comments when complaining about their PS3 being broken. Police were called and a report was done. LPA reviewed Special Incident Report (SIR) sent to CCLD regarding incident and police report case number.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was discussed and provided to the Administrator.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

LIC9099 (FAS) - (06/04)

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