198602403-9-4-2024-28-AS-CDCN-D8SMXM-20240904100011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602403
Report Date: 09/04/2024
Date Signed: 09/04/2024 10:10:31 AM

Document Has Been Signed on 09/04/2024 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	HAPPY HOME CARE FOR ELDERLY		FACILITY NUMBER:	198602403
ADMINISTRATOR:	JUNG HYUN, KIM		FACILITY TYPE:	740
ADDRESS:	23801 SAPPHIRE CANYON RD		TELEPHONE:	(909) 396-1645
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 4	DATE:	09/04/2024
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jung Hyun Kim, licensee		TIME COMPLETED:	10:00 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On September 4, 2024, Licensing Program Manager (LPM) Tony Vasallo and Licensing Program Analysts (LPAs) Cynthia Chan and Kimberly Ramirez held an office meeting to follow up on the concluded investigation of the double homicide that occurred at the facility on June 24, 2023.

The investigation revealed that on June 25, 2023, the news media broadcasted a report of a double homicide at the facility. On the same day, licensing staff conducted an initial visit to obtain staff and resident records. Licensing staff also conducted interviews with two staff and attempted to interview the four remaining residents who were not able to respond due to cognitive impairment. Staff 1 (S1) was not available for interview as S1 was detained by the police.

On August 24, 2023, Investigator Ryan Miles and LPA Christine Wong interviewed S1 at the jail. S1 spoke about their previous job experience that was not related to caregiving; how they obtained the job on the spot as a live-in caregiver; training they received; and the living environment at the facility. S1 acknowledged the killing of resident 1 (R1) and resident 2 (R2) but did not want to discuss details of what transpired.

At the time of the case management visit conducted on October 10, 2023, an immediate civil penalty of $500 was issued for Section 87468.2 Additional Personal Rights for failure to provide care, supervision, and services. The licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code 1569.49(e).

The Department has concluded an analysis and has determined that an additional civil penalty is warranted for a violation that the Department determined resulted in the death of R1 and R2. This is evidenced by the licensee’s failure to protect the safety of two residents who were killed on site while under the care and supervision of a licensed residential care facility for the elderly. In addition, the licensee did not train staff adequately or obtain a criminal record clearance prior to S1 working and residing at the facility.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY HOME CARE FOR ELDERLY	FACILITY NUMBER: 198602403
	VISIT DATE: 09/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Today, September 4, 2024, the Department will be issuing a civil penalty per Health and Safety Code 1569.49(e) for a violation that the Department determines resulted in the death of two residents in the amount of $30,000 ($15,000 for each death of a resident). However, since an immediate civil penalty of $500 was previously issued on October 10, 2023, the amount of the civil penalty today will be $29,500.

Copies of the 421D were provided to Jung Hyun Kim and originals were signed.

Exit interview conducted. A copy of the report issued. Appeal rights provided to Jung Hyun Kim, and signature on this report acknowledges receipt of the Appeal Rights, which is found on page 2 of the LIC421D.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2