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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 04/14/2025
Date Signed: 04/14/2025 06:41:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/08/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250408085050
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: 60DATE:
04/14/2025
UNANNOUNCEDTIME BEGAN:
02:16 PM
MET WITH:Administrator, Tae KimTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Due to lack of supervision, resident has eloped multiple times
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to the facility to conclude the investigation of and deliver findings to the above mentioned complaint. LPA met with Administrator, Tae Kim who was informed of the reason for today's visit. The investigation consisted of observations, interviews with residents and staff and record review.

It is alleged that due to lack of supervision, resident has eloped multiple times. The investigation was conducted by LPA Farlow obtained evidence to corroborate the allegation above. Through the information gathered during the investigation, it was confirmed by observation, documents review and interviews that R1 requires more supervision and is unable to leave the facility unassisted.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20250408085050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
VISIT DATE: 04/14/2025
NARRATIVE
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Based on LPA Farlow's observations, interviews and records review, the preponderance of evidence standard has been met, and therefore the above allegation of due to lack of supervision, resident has eloped multiple times is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 6) is being cited on the attached LIC9099D.

An exit interview was conducted where this report (LIC9099), LIC9099C, LIC9099D, and Appeal Rights were discussed and provided to Administrator Tae Kim.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 56-AS-20250408085050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2025
Section Cited
CCR
87463(C)
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87463(C)Behavioral expression, as defined in..that may result in harm to self or others,..unsafe wandering, elopement,..lacking in hazard awareness, or lacking in impulse control.
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Licensee agrees to provide care and supervsion as needed to ensure a safe environment for residents in care. Licensee agrees to complete a reappraisal to ensure resident is safe from wandering and elopement.
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Based on observation, record review, and interviews, the licensee did not comply with the section cited above by not ensuring resident did not leave the facility unassisted.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3