Ambiance: 4. Old world feel inside is enhanced by occasionally accordion playing right in the heart of Cleveland's Little Italy (which coincidentally sits right next to some great dessert spots). That said, the main dining room is a little noisy for this kind of Italian meal, and the secondary room is quiet but feels just too secluded.
Cost: 3. Great medium-sized Italian portions, in line with most Little Italy prices (~low $20s for most pasta dishes and high $20s/low $30s for meats). Note that items are a la carte so salads/appetizers do add up quickly. More positive is that they are reasonable on wine prices.
Food Quality: 4. Gusto does a great job of adding unique flavors into everyday Italian dishes, and explaining that in English on the menu. For example, our party ordered the bruschetta that was topped with white truffle oil. Pasta dishes were all outstanding, highlights including the veal tortellini and seafood lasagna. Gusto seems to specialize in cream based sauces, which probably isn't best for our hearts but was awesome at the time for our stomachs & brains.
Service: 5. Great waitress + remaining wait staff. Even though we dined rather late, we weren't rushed through our meal and owner (at least I think it was owner) came by to see how we were doing shortly after our main courses. Bottom line: they care.
When to return: Whenever you're craving Little Italy, especially for a nice night out with a significant other or a few friends. Might be an avoid on a first/second date due to noise in the main dining room, seclusion in the other room. Great spot in summertime for 2 in front on the patio.