361880660-7-2-2021-18-AS-JESL-C6EV5M-20210831160810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 07/02/2021
Date Signed: 07/02/2021 04:10:30 PM

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
02/17/2021 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210217085337

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: 47	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Tae Kim - Assistant Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility has pests

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 Tae Kim and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility has pests": LPA Colvin conducted interviews both during today's visit as well as on 2/26/21 when the initial complaint visit was done telephonically. LPA Colvin reviewed documents requested from the facility regarding pest control and prevention and observed that the facility is checking the kitchen for pests and spraying multiple times a week. During today's visit LPA Colvin conducted an inspection of the kitchen, which included looking under appliances, and did not observe any pests or evidence of recent pests.
Due to interviews, record review, and observations made by LPA Colvin, the complaint is 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 with Tae Kim and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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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