361880660-7-13-2023-18-AS-JESL-CU8SD3-20230730134628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 07/13/2023
Date Signed: 07/13/2023 05:00:14 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
03/30/2020 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200330084611

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:	01:49 PM
MET WITH:	Administratot, Tae Kim		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff are not meeting residents' toileting needs
Staff are not assisting residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings on the above allegations. LPA met with Administrator, Tae Kim who was informed of the purpose of the visit.

During the visit, LPA conducted interviews, documented observations, and conducted records reviews. Regarding allegation, “staff are not meeting resident’s toileting needs”, it was alleged that residents smelled of urine during lunch service due to caregivers being assigned to serve residents during this time. LPA interviewed (4) resident during the time of the visit and found that none smelled of urine. Resident stated they were changed by caregivers. LPA interviewed (5) staff who stated that residednt are changed on a regular basis.

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-20200330084611

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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Additionally staff interviewed stated that at the time the complaint was received, the facility was not using the dining area for meal service due to COVID restrictions. Staff stated all residents were served in their room at this time and only caregivers bringing meals into the residents room. Based on the above, the allegation was found to be unsubstantiated. preponderance of the evidence standard has not been met.

Regarding “staff are not assisting residents”, it was alleged that residents that were residing in room #48 were being neglected by staff. It was also alleged that staff would “goof around” instead of assisting the residents LPA spoke with administrator who stated Resident #1 (R1) was residing in room #48 at the time the complaint was received. Administrator stated they could not recall if another resident was residing in this room at the time. LPA interviewed current administrator and past administrator who stated they did not have any concerns with staff not doing their work at this time and not attending to the residents. Current administrator Kim stated that care giving staff has turned over from 2020. LPA interviewed R1 who stated no concern to the LPA. Therefore, the allegation was unable to be corroborated and found to be unsubstantiated.

Findings that are unsubstantiated mean that the preponderance of the evidence standard has not been met.

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

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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