361880660-8-13-2021-18-AS-CCON-C5UTBA-20210813143451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361880660
Report Date: 08/13/2021
Date Signed: 08/13/2021 02:35:02 PM

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
RIVERSIDE, CA 92507

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: 45	DATE:	08/13/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Tae Kim - Assistant Administrator		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of investigating recent concerns received regarding facility operations. LPA Colvin met with Assistant Administrator Tae Kim and advised him of the purpose of the visit. Below is a summary of items discussed/addressed: Residents' Mail: Concerns were brought to LPA Colvin's attention regarding how staff are handling residents' mail, specifically in regards to incoming checks. LPA Colvin reviewed the facility's financial logs for the residents, as well as relevant social security information. LPA Colvin additionally interviewed staff who process resident mail and handle resident monies at the facility. LPA Colvin determined that the facility is acting in accordance with their responsibility as payee for residents for whom they are Representative Payee. The checks for these residents come addressed to "Rialto Assisted Living, for _____ (resident)". The facility cashes the checks and sorts the money accordingly. LPA Colvin did not find any evidence to suggest that the facility staff are mishandling residents' mail. Stimulus Checks: LPA Colvin was anonymously asked to look into residents' receiving stimulus checks, and how the facility is processing these, as the party claimed to be unaware of the funds. LPA Colvin reviewed facility logs for resident finances that the facility handles, and discussed with facility staff how the stimulus checks for residents were processed, and if residents were informed of the funds. LPA Colvin was informed that the facility only processed (cashed) checks for residents for which they are Representative Payee, and this money was then added to the residents' spending fund (P&I). LPA Colvin was additionally informed that residents that the facility does not handle money for were given their stimulus checks along with their unopened mail, in accordance with regular facility practices. LPA Colvin recommended to assistant Administrator Tae Kim that since LPA Colvin was advised that at least one resident was unaware of their stimulus funds, and since there are additional checks that are being sent out again, to go over the P&I logs with each resident to ensure that they are aware of all funds.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RIALTO ASSISTED LIVING	FACILITY NUMBER: 361880660
	VISIT DATE: 08/13/2021

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LPA Colvin additionally recommended to have the residents sign and date next to the entries documenting every stimulus check that was deposited for the resident, as a way to show that residents have been informed by the facility of receipt of the checks. Assistant Administrator Tae Kim was receptive to this suggestion and agreed to look into how to add this to the current log.

Bed Bugs: LPA Colvin was provided with information regarding a bed bug infestation in Room #35. LPA Colvin received pictures and video of bed bugs in a resident's (R1) bed, dated 8/6/21. LPA Colvin conducted a brief inspection of Room #35 and observed what appeared to be a small bed bug crawling on the ceiling near a vent above R1's bed. LPA Colvin additionally conducted interviews which also stated that bed bugs had been spotted in both resident beds for Room #35.

LPA Colvin interviewed maintenance staff and Assistant Administrator Tae Kim regarding any recent concerns of bed bugs in the facility. LPA Colvin was advised that there had been a concerned with bed bugs in Room #35, but that it had been addressed by maintenance staff on 8/6 or 8/9 with a bed bug spray, and that this was no longer an issue to their knowledge. LPA Colvin showed a picture taken by LPA Colvin today for the bed bud on the ceiling in Room #35 and suggested that the facility take additional action to treat the bed bug problem in Room #35, such as possibly temporarily moving the residents to a vacant room while the affected room is treated more thoroughly. LPA Colvin will be citing a deficiency for the bed bug infestation in Room #35, as the problem has persisted and the facility has not taken sufficient measures to eradicate the pests. This facility has had numerous occurrences in the past with bed bugs, and has taken additional measures (such as having an exterminator come out to treat the rooms) to ensure that the issue is resolved. This was not done in this instance and the problem with the bugs continues to affect the residents in Room #35. Deficiency cited.

The facility was cited a deficiency which is detailed on the LIC809D. A copy of this report, LIC809D, LIC9102TV, and appeal rights were provided to Assistance Administrator Tae Kim during the exit interview.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 08/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/20/2021 Section Cited	1 2 3 4 5 6 7	Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on interviews and observations, the Licensee did not comply with the above regulation with one resident room (#35). LPA Colvin observed a bed bug on the ceiling above R1's bed in Room #35. Facility has only sprayed the perimeter of the room. This is a potential health and personal rights violation.	8 9 10 11 12 13 14	or detailed self-certification of additional treatment for bed bugs in Room #35. Licensee to additionally create a log for housekeeping staff to note whether or not any pests (including bed bugs) were cited each day of cleaning. Log to be implemented for at least one month for Room #35.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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