361880660-8-11-2022-56-AS-KCLS-CS4TBL-20230523143519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 08/11/2022
Date Signed: 08/11/2022 03:10:33 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
08/04/2022 and conducted by Evaluator Rohit Lama

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220804112846

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: 44	DATE:	08/11/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kyong Suk Lee, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident is not being provided adequate meal service while in care

INVESTIGATION FINDINGS:

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At 10:00 AM on 08/11/2022, Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegation listed above. LPA met with Kyong Suk Lee, Administrator.

LPA interviewed the Administrator, Staff #1 (S1), Staff #2 (S2), Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5).

According to the allegation above, a resident is not being provided adequate meal service because he is being denied food service when he arrives late. When LPA interviewed the Administrator, S1, and S2, all individuals stated that food service is never denied to residents. Furthermore, all three stated that Tray Service is provided upon request if a Resident does not want to eat at the dining table.

CONTINUED ON LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit Lama	TELEPHONE: 951-217-9826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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-20220804112846

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: 08/11/2022

NARRATIVE

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CONTINUED FROM LIC 9099

Four out of five residents, when interviewed, stated that they have never been denied food service. The same residents stated that food is provided regardless of if they were delayed in getting to the dining room.

Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated. 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, therefore the allegation is Unsubstantiated.

LPA conducted an exit interview where this report was discussed with the Licensee. A copy of this report was provided to the Administrator at the conclusion of this investigation.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit Lama	TELEPHONE: 951-217-9826
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

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