361880660-10-10-2024-56-AS-EMAN-DAXVRS-20241112154026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 10/10/2024
Date Signed: 10/10/2024 02:49:37 PM

Unsubstantiated

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
10/03/2024 and conducted by Evaluator Lavette Farlow

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241003140957

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: 72	DATE:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	11:23 AM
MET WITH:	Tae Kim, Administrator		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff are not properly maintaining resident’s bathroom

INVESTIGATION FINDINGS:

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Licensed Program Analysts (LPAs) LaVette Farlow and Magda Malcore arrived at facility to commence a complaint investigation. LPAs met with Administrator, Tae Kim and discussed the purpose of the visit. The investigation consists of LPAs observations, obtaining and reviewing facility records, and interviews with staff and residents.

It is alleged that staff are not properly maintaining resident’s bathroom. During staff interviews, it was revealed that Housekeeping is conducting a daily spot check of all residents rooms and a weekly deep cleaning of residents rooms. After speaking with Staff #3 (S3), it was revealed that (S3) noticed the shower curtain needed to be replace in Resident #1s (R1s) bathroom. (S3) asked (R1) if they had another curtain. (S3) stated that (R1) stated they did not. (S3) stated they had a very busy day and was unable to change the curtain that day. (S3) further stated they became ill and was out for several days. Upon return, (S3) was reminded to replace the curtain. (R1) stated that the curtain was replaced yesterday, 10/09/24.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Lavette Farlow	TELEPHONE: 951-248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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 56-AS-20241003140957

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: 10/10/2024

NARRATIVE

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LPAs conducted a tour of the facility and observed that five (5) out of (5) residents' rooms were maintained to be free of odor and clean. LPAs observed that each bathroom, sink, toilet, and shower were maintained clean. Five (5) out of five (5) residents stated that housekeeping cleans their rooms once a week or more often as needed.

Based on interviews conducted, the one (1) above allegation is deemed Unsubstantiated. A finding of unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted this report was reviewed, discussed, then provided to Administrator, Tae Kim, at the conclusion of the visit.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Lavette Farlow	TELEPHONE: 951-248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

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