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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 09/17/2024
Date Signed: 11/18/2024 11:36:08 AM

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
09/13/2024 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20240913115145
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: 71DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Irene Silva, Marketing DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff unlawfully evicted a resident
INVESTIGATION FINDINGS:
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*** This is an amended report to correct LIC 9099 dated and signed on 09/17/2024***
Licensed Program Analysts (LPAs) Lavette Farlow, and Bernardette Allen conducted an unannounced visit to the facility to conduct a investigation and deliver finding. LPAs were granted entrance into the facility by Irene Silva, Marketing Director. LPAs identified themselves and discussed the purpose of the visit.

LPAs conducted interviews with staff, resident, reviewed and obtained documents and conducted a walk-through of the facility.

The investigation consisted of file review, interviews with staff and resident 1 (R1). The interview with R1 and facility staff, stated R1 has not been in compliance with the admission agreement and house rules. R1 has also stated there has been past and recent incidents with other residents and destruction of facility property.

On 06/23/2023, a written warning was given to R1. Since that time their has been several incidents with other residents in care of where R1 had made verbal threats and on another occasion staff observed R1 and he appeared to be under the influence of alcohol.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Lavette FarlowTELEPHONE: 951-248-0304
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 2
Control Number 56-AS-20240913115145
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: 09/17/2024
NARRATIVE
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Based on the evidence gathered during investigation, the above allegation was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted where this report LIC9099, LIC9099C was discussed and provided to Tae Kim Administrator at the conclusion of the visit with appeal rights.

SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Lavette FarlowTELEPHONE: 951-248-0304
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
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