361880660-7-12-2024-56-AS-EMAN-D7ARPT-20240718131224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 07/12/2024
Date Signed: 07/12/2024 10:45:40 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/12/2024 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240412132519

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: 64	DATE:	07/12/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tae Kim - Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff are not addressing resident's fall risk.
Resident sustained an unwitnessed fall due to lack of staff supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Tae Kim and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff are not addressing resident's fall risk. During interviews and review of records LPA discovered that after Resident #1 initial falls, facility addressed to Resident #1 responsible party about the concerns of resident falls along with the possibility of resident needing to be placed on a higher level of care such as a Skilled Nursing Facility (SNF). Resident #1 responsible party suggested for resident to remain at Assisting Living Facility (ALF), with increased supervision. Through record review LPA observed that Rialto Assisted Living, implemented a treatment plan for Resident #1 which included: logged hourly routine checks along with bed/wheelchair alarm sensor pads to help minimize the risks for Resident #1 from falling. On 7/12/2024 LPA conducted a room inspection for Resident #1 to confirm that Resident #1 treatment plan was implemented. During the inspection LPA observed that alarm/sensor pads were applied LPA also observed that facility implemented hourly routine check longs for Resident #1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

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-20240412132519

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: RIALTO ASSISTED LIVING	FACILITY NUMBER: 361880660
	VISIT DATE: 07/12/2024

NARRATIVE

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Second Allegation, Resident sustained an unwitnessed fall due to lack of staff supervision. During interviews and review of records LPA obtained an employee roster and observed facility to have sufficient care staff coverage to provide care for all residents in care. LPA also obtained an on-call employee roster in-case the facility needs coverage to provide care for all residents. LPA conducted interviews with staff pertaining to Resident #1 unwitnessed fall and all staff indicated that resident fall was the result to Resident #1 not being able to verbalize and transferring out of bed or wheelchair without care support assistance. LPA conducted interviews with residents pertaining to their overall needs and care and five out of five residents stated not having issues or concerns pertaining to their needs and care. In addition, five out of five residents stated that their needs and care are being met by caregivers at the facility. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Tae Kim.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC9099 (FAS) - (06/04)

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