361880660-12-17-2021-18-AS-JESL-CSE7VP-20230601220014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:07:40 PM

Substantiated

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
11/23/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201123163753

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: 48	DATE:	12/17/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Janet Oliver - Marketing Director		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to deliver findings on the open complaint with the allegation above. LPA Colvin met with Marketing Director Janet Oliver and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility is in disrepair": For this investigation, LPA Colvin conducted interviews and reviewed facility records in regards to a reported ceiling collapse in Room #32. Through investigation, LPA Colvin learned that the reported ceiling collapse occurred on 11/23/20, at which time the occupant of the room was temporarily relocated. Upon further follow up on the status of the repairs of the room on 12/15/20, LPA Colvin was informed by facility staff that Room #32 was still under repair, and that the ceiling had not been finished. This fact was supported by facility maintenance logs, which showed Room #32 being periodically worked on from 11/25/20 to 12/15/20 (date records were requested). Though the facility had ongoing work scheduled to complete the repairs for the ceiling, the extended time that it took for the project to be completed left the occupant of Room #32 displaced from their room for over three weeks.

Substantiated

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: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

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-20201123163753

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: 12/17/2021

NARRATIVE

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Therefore, based on interviews and record review, the allegation "Facility is in disrepair" is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiency noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy of all reports, forms, and appeal rights were provided to Marketing Director Janet Oliver during the exit interview.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20201123163753

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/31/2021 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met by:	1 2 3 4 5 6 7	Licensee agrees that in the future, all repairs will be completed within a timely manner, especially when the repair directly affects a resident. Licensee to provide LPA Colvin with a Statement of Understanding of this expectation by the Plan of Correction date of 12/31/21.
	8 9 10 11 12 13 14	Based on interviews and record review, the Licensee did not comply with the above regulation with at least one area of the facility. LPA Colvin confirmed that Room #32 was in a state of disrepair for over 3 weeks, leaving the occupant displaced. This was a potential personal rights violation of the occupant.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC9099 (FAS) - (06/04)

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