361880660-8-13-2021-18-AS-JESL-CKQQTZ-20221031122758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 08/13/2021
Date Signed: 08/13/2021 02:35:56 PM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200709144134

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:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Tae Kim - Assistant Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility denied resident a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Assistant Administrator Tae Kim and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility denied resident a refund": For the investigation of this allegation, LPA Colvin conducted interviews and reviewed relevant records regarding the resident (R1). In LPA Colvin's review of these records, LPA Colvin confirmed that R1 signed an Admissions Agreement with the facility on 2/22/19 which outlined the monthly rates, causes for eviction, and refund policy. R1 left the facility via ambulance on 5/8/20 due to continued medical complecations, for which the facility could no longer care for and were unable to meet R1's needs. On the date that R1 left via ambulance, it was communicated to R1's Power of Attorney (POA) that R1 would not be admitted back to the facility when she is ready for discharge, due to these continued issues which have lead to recent hospitalizations. The Administrator provided LPA Colvin with a picture of a refund check that was sent out to R1's POA, dated 5/11/20 for $801.30.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 18-AS-20200709144134

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: 08/13/2021

NARRATIVE

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The Administrator additionally provided LPA Colvin with a picture of the Return Receipt showing that the check was sent via Certified Mail, as well as the retail receipt showing the purchase for sending the mail. LPA Colvin was informed that the check was a refund for the remaining days of the month of May 2020 that R1 would not be residing in the facility, as R1 had previously been issued an eviction notice and the facility would not be accepting R1 back from the hospital.

According to R1's Admissions Agreement with the facility, R1 was being charged $1,080 each month, or approximately $36 per day. Since R1 paid $1,080 for the month of May 2020, but only stayed at the facility for eight days (until 5/8/20), then if R1 was charged the $36 daily rent fee for eight days, R1 would owe the facility $288 for R1's time at the facility. Record review shows that R1 was effectively only charged $278.70 for the eight days in May 2020, as the facility issued a refund in the amount of $801.30 to R1's POA. Additionally, R1 is not entitled to any additional funds for time spent at the hospital during a previous hospitalization in February 2020, as page eight (item "J") of R1's signed Admissions Agreement clearly states "If a resident leaves the facility temporarily, the holding for his/her room is $36 per day. At the end of the item, there is a space for the resident to initial, which R1 did.

This agency has investigated the complaint alleging "Facility denied resident a refund". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Assistant Administrator Tae Kim and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
07/09/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200709144134

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:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Tae Kim - Assistant Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not administer residents medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Assistant Administrator Tae Kim and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Staff did not administer residents medication": LPA Colvin reviewed medication records from both the facility and Home Health for R1, as well as conducted interviews with relevant parties. Review of the medication records show that R1 was prescibed two topical medications for R1's rash, both of which the facility documents both some administration of and a significant amount of refusals from R1 for administration of the medications. LPA Colvin additionally confirmed through Home Health records that R1 had a pattern for refusing the medications in addition to other treatment for the rash (washing and changing of dressing). LPA Colvin observed that the facility's Medication Administration Report (MARs) for the months of April 2020 and May 2020 only included signatures for when the medication was succesfully administered, and no markings to reflect the dates and times that R1 refused.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20200709144134

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: 08/13/2021

NARRATIVE

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LPA Colvin was informed that the refusals were documented separately on staff notes, which LPA Colvin reviewed and observed, but these notes were not all-inclusive of the dates missing notation on the MARs log. LPA Colvin was additionally told through interviews that due to the number of times R1 would refuse the medications (more often than not), the dates were simply left blank and were known by staff to be refusals. Since it is not in Title 22 Regulations that a facility must utilize and maintain a MARs Log, LPA Colvin cannot impose upon the facility how they are to document the refusals (marking it on the log versus making a separate note in the file). Additionally, though the facility staff notes did not include all dates missing notation in the MARs log, R1 has a substantial documented history of refusing medication, which LPA Colvin confirmed through Home Health records as well. Therefore, it is plausible that facility staff made attempts to administer the topical medication to R1 as frequently as prescribed. Additionally, facility staff are unable to forcibly administer medication to any residents in accordance with Title 22 Regulations, therefore, dates where the resident refused and medication was not administered staff were unable to administer medication due to needing to uphold residents' rights to refuse treatment.

Due to interviews, record review, and observations made by LPA Colvin, the complaint is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted with Assistant Administrator Tae Kim and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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