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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880660
Report Date: 12/17/2021
Date Signed: 12/17/2021 05:23:35 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
03/24/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200324111109
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: 48DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kyong "Clara" Suk Lee - AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility's supplies are stored in unsanitary manner
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 Administrator Kyong "Clara" Suk Lee and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility's supplies are stored in unsanitary manner": LPA Colvin conducted a visual inspection of the area of concern in the allegation, which was specific to how paper towels in the bathroom are being stored. LPA Colvin inspected the common bathroom near the nurse station, and observed that although there is a paper towel dispenser installed on the wall, the paper towel roll is left on the counter. LPA Colvin tested the dispenser, in case the paper towels on the counter were extras, and observed that no paper towels were dispensed from the machine. By leaving the paper towel roll on the counter of the sink, persons washing their hands will need to (or have the opporunity to) grab the entire roll with their wet hands in order to dispense the amount needed. Even with LPA Colvin's best efforts, LPA Colvin failed to get paper towels from the roll without getting water from her wrist on the roll, thereby contaminating the remaining items.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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 5
Control Number 18-AS-20200324111109
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
VISIT DATE: 12/17/2021
NARRATIVE
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LPA Colvin additionally observed that there is no other means to dry one's hands in the common restroom, such as an air dryer. Therefore, based on observations made, the allegation of "Facility's supplies are stored in unsanitary manner" is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiency noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy of all reports, forms, and appeal rights were provided to Administrator Kyong "Clara" Suk Lee during the exit interview.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20200324111109
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2021
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met by:
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Licensee agrees to utilize another means for persons using the common bathroom sink to dry their hands without concern of contamination from other persons (i.e. paper towel dispenser, air dryer, etc.). Licensee to provide LPA Colvin with plan and photographic proof of utilization by Plan of Correction date.
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The Licensee did not comply with the above regulation with at least one area of the facility. LPA Colvin observed that paper towels in the common bathroom are stored on the counter, and not in the dispenser which is on the wall. This is a potential health risk to all persons.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/24/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200324111109

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: 48DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kyong "Clara" Suk Lee - AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility does not have hot water
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 does not have hot water": For this investigation, LPA Colvin conducted interviews and reviewed facility maintenance records as well as invoices for the facility for plumbing services. This complaint was received on 3/24/20 with reports of there not being hot water as of 8:30am. LPA Colvin was provided with a copy an invoice from a plumber, dated 3/24/20 for the services of changing a water pipe. LPA Colvin confirmed that while there was in fact no hot water for a period of time on 3/24/20, this was due to plumbing repairs, which were completed that day. LPA Colvin observed that the facility addressed the concerns with the water fixtures at the facility in a prompt manner. Therefore, due to interviews and record review, the allegation of "Facility does not have hot water" is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20200324111109
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RIALTO ASSISTED LIVING
FACILITY NUMBER: 361880660
VISIT DATE: 12/17/2021
NARRATIVE
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A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegations occurred.

A copy of this report was provided to Administrator Kyong "Clara" Suk Lee during the exit interview.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5