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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880660
Report Date: 02/28/2025
Date Signed: 02/28/2025 07:20:09 PM

Document Has Been Signed on 02/28/2025 07:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
361880660
ADMINISTRATOR/
DIRECTOR:		KYONG SUK LEEFACILITY TYPE:
740
ADDRESS:1441 S RIVERSIDE AVETELEPHONE:
(909) 877-2340
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 94TOTAL ENROLLED CHILDREN: 0CENSUS: 63DATE:
02/28/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:36 PM
MET WITH:Tae Kim, Administrator TIME VISIT/
INSPECTION COMPLETED:
07:28 PM
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Licensing Program Analyst, LaVette Farlow, (LPA) arrived at Rialto Assisted Living, unannounced to conduct a Case Management Visit for health and safety and conduct interviews for a complaint. This case management visit is in response to a Special Incident Report, (SIR) submitted to the Community Care Licensing Office on 02/01/2024. LPA was greeted by Med-Tech Rayleen Moya at the Med-Tech station and escorted to the library. LPA introduced self and stated purpose of the visit.

During today's visit, LPA conducted a health and safety check and conducted interviews with staff and clients.

No deficiencies were observed during this visit. An exit interview was conducted where this report was, reviewed, discussed and then provided to Administrator Tae Kim.
Nedra BrownTELEPHONE: (951) 202-5776
Lavette FarlowTELEPHONE: 951-248-0304
DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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