361880660-7-25-2023-56-AS-NBRN-CU6P34-20230728105656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 07/25/2023
Date Signed: 07/25/2023 11:09:15 AM

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
06/29/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230629140718

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: 50	DATE:	07/25/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Bernie Escueta, Medication Technician Sup.		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Resident Sustained Multiple Falls While in Care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Rialto Assisted Living Facility to deliver the findings of the complaint investigation. LPA signed in, introduced self and stated purpose of the visit. LPA Administrator was not available. LPA spoke with Medication Technician Supervisor.

It is alleged that the resident sustained multiple falls while in care. Staff interviews revealed that the resident does not have a history of falls while admitted to Rialto Assisted Living. The resident had one fall recently, which led to transport to the emergency room. The fall was self-reported by the resident themselves. Initially, the resident refused to be taken to the hospital for evaluation. They agreed to see the in-house doctor who recommended the resident go to the hospital. The resident again, refused the doctor's advice to go the emergency The following date, the resident became ill, and asked to be taken to the hospital – which was granted. LPA reviewed the resident’s Physician Report and discharge paperwork which made no mention of a history of the resident falling and sustaining injuries. Witness’s statements are consistent with one another; they support that the resident does not have a long

Please see LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

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-20230629140718

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: 07/25/2023

NARRATIVE

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history of falling. During resident interviews, it was discovered that the resident does have some history of falls but these incidents occurred long before moving into Rialto Assisted Living. Resident reported having one fall, which was not reported and the second fall being 6/26/23. This fall was reported late because the pain and discomfort did not present itself until days later.

Based on observations, review of documents and interviews, we have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

LIC9099 (FAS) - (06/04)

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