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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 12/17/2021
Date Signed: 12/17/2021 11:56:48 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/06/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200306154047
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: 48DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Janet Oliver - Marketing DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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*Facility did not seek medical attention timely for a client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Marketing Director Janet Oliver and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility did not seek medical attention timely for a client in care": The Department conducted interviews and reviewed documents from the facility and hospital for the resident (R1) and evaluated R1's arriving condition at the hospital on February 28, 2020 as well as services provided to R1 at the facility. R1’s rash was originally discovered by facility staff on February 23, 2020, but the staff member that discovered the rash failed to report the observation to R1’s Power of Attorney (POA) or seek medical assistance for R1. The following day on February 24, 2020, the facility called 911 due to their concerns regarding the rash, but R1 refused to be transported to the hospital. Facility staff report, they attempted to contact R1’s POA on February 24, 2020but were unable to get in contact with them.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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 5
Control Number 18-AS-20200306154047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2021
Section Cited
CCR
87466
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Observation of the Resident:...shall ensure that residents are regularly observed for changes...and that appropriate assistance is provided...the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.
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Administrator and all care staff to complete training on observations of residents, including changes in condition and warning signs of possible undiagnosed underlying medical conditions. Administrator to additionally ensure all current residents have updated Needs & Services Plans.
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This regulation was not met by: Based on interviews and record review, the Licensee did not comply with the following regulation in that Administrator observed resident to have a significant change in condition and did not re-evaluate for level of care, resulting in infected wound. This was an immediate risk to R1.
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If any residents have Needs & Services Plans that are older than 1 year, the Administrator shall evaluate the resident and update their Needs & Services Plans in accordance with Title 22 Regulation Section 87463. Administrator to provide LPA Colvin with proof of training for self & all care staff by 12/20/21.
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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.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20200306154047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/17/2021
NARRATIVE
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 No further steps were made to seek medical treatment for R1 until several days later, on February 28, 2020 when R1’s POA went to the facility to check on R1 and observed the large rash on R1’s chest. With the assistance of R1’s POA, 911 was called and R1 was successfully transported to the hospital where R1 was treated for the infected rash.

During the investigation it was revealed that prior to R1’s hospitalization, R1 had not been seen by a doctor nor had an updated assessment since 2015. Additionally, interviews revealed that the Administrator was aware that R1’s needs were greater than what was reflected in the facility’s written record of care, yet the facility had not taken any measures to update their assessment of the resident. Interviews also revealed that R1 was observed to have a recent decline in condition in the last two months and was refusing staff assistance with showering and toileting. Facility staff documented R1’s refusals and their attempts to contact R1’s Power of Attorney, but no further action was taken.

The facility failed to provide adequate observation and care of R1, which resulted in R1 being admitted to the hospital for an infected rash. Therefore, based on interviews and record reviews, the above allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiency noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy of all reports, forms, and appeal rights were provided to Marketing Director Janet Oliver during the exit interview.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/06/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200306154047

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: DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin contacted the facility to deliver findings of the above allegation(s) via telephone due to COVID-19. LPA Colvin went over the investigation and findings with Marketing Director Janet Oliver. Below are the findings of this investigation:

Regarding the allegation "Illegal eviction": LPA Colvin reviewed relevant documentation including Eviction Notice (dated 2/8/20), communications from facility staff, resident's (R1) signed Admissions Agreement, and facility's House Rules. In review of all of the relevant documentation, LPA Colvin observed that the Eviction Notice that was served to R1 and sent to their Power of Attorney (POA) on 2/8/20 provided two reasons for resident's eviction, both of which are in accordance with possible reasons for eviction listed in the facility's Admissions Agreement (not following facility rules & facility unable to meet resident's needs). Additionally, facility staff re-evaluated R1 in the hospital (as is outlined in the facility's Admissions Agreement) in March 2020 to determine if the facility would be able to meet their needs upon hospital discharge.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20200306154047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/17/2021
NARRATIVE
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After evaluating R1's condition and needs in the hospital, the facility determined that they would still not be able to meet R1's needs and were concerned that R1 would end up in the same condition, requiring emergency medical care, should they readmit R1 to the facility.

LPA Colvin reviewed Title 22 Regulations regarding Eviction Procedures and confirmed that the facility's Admissions Agreement was in line with Title 22 regarding under what circumstances the facility may issue an eviction notice to a resident. Additionally, the facility continued to abide by the Admissions Agreement, which was signed by R1, wherein they re-evaluated R1 in the hospital to determine if R1's needs/condition had changed, and if the facility would now be able to provide adequate care for R1. The facility determined that they would still not be able to meet R1's needs, and therefore decided not to readmit R1 as of March 6, 2020. The facility's Admissions Agreement expressly states that if a resident is in the hospital and the facility determines that they will not be able to provide sufficient care for the resident at the facility, that they will not readmit the resident back to the facility at that point. This agency has investigated the complaint alleging unlawful eviction. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted where this report was discussed. A copy of all reports and forms were provided to Marketing Director Janet Oliver during the exit interview.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5