361880660-7-13-2023-18-AS-JESL-CU8SBV-20230730134435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 07/13/2023
Date Signed: 07/13/2023 05:04:18 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2020 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200414084250

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: 51	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Administrator, Tae Kim		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff is stealing resident's medication
Staff is selling resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA met with Administrator, Tae Kim who was informed of the purpose of the visit. The department conducted interviews, documented observations, and conducted records reviews.

It was alleged “Staff is stealing resident's medication”, and "staff is selling resident's medication", with allegations identify Staff #1 (S1). During today’s visit LPA conducted a random inventory of (4) resident medications who take controlled narcotics. All medications were accounted for. S1’s staff file was reviewed and found that on 4/16/2020 S1 had received a write up.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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 18-AS-20200414084250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: RIALTO ASSISTED LIVING	FACILITY NUMBER: 361880660
	VISIT DATE: 07/13/2023

NARRATIVE

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The narrative stated the staff was observed taking the medication cart to the door while speak with an unidentified male outside the facility. LPA interview past administrator who gave the write up who stated they had given the write up because they had taken the cart to the door and left it unattended while speak with the male. LPA spoke with (3) staff who all stated the same version of events, including S1. Past administrator stated they did not do an inventory of medications as it was observed on the facility footage that S1 had simply left the cart unattended. LPA interviewed past administrator, current administrator, S1's supervisor who stated that they were not aware of allegations stating S1 had sold resident medication. LPA interviewed (4) facility residents, (3) of which stated they had not witnessed the S1 steal or sell medications. They stated they had no concerns about the staff, or repeated incidents of the same nature since the write up. Therefore, the allegation that staff was stealing resident medication is unsubstantiated.

An exit interview was conducted with Administrator, Tae Kim where this report was reviewed and provided to them.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

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