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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880660
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:33:15 PM


Document Has Been Signed on 08/07/2023 03:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
361880660
ADMINISTRATOR:KYONG SUK LEEFACILITY TYPE:
740
ADDRESS:1441 S RIVERSIDE AVETELEPHONE:
(909) 877-2340
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:94CENSUS: 51DATE:
08/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:ADMINISTRATOR TAE KIMTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility to continue the investigation of the following complaints listed below and to deliver amended allegation finding for complaint number: 18-AS-20201203110823. LPA met with Tae Kim, Administrator.

The following complaint allegations were fount to be UNSUBSTANTIATED.
    • 18-AS-20201210082804
    • 18-AS-20201208165511

Complaint control number 18-AS-20201203110823 has been amended to UNSUBSTANTIATED.

Administrator Kim signed all LIC 9099 and LIC 809 during today's visit. All reports were discussed with and copies were provided to Administrator Kim at the conclusion of today’s visit.

SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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