198602403-9-5-2024-28-AS-RORN-DABPGY-20241023111901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602403
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:13:16 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240605153844

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:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kim Gi Soung		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff suffocated residents resulting in death of residents.
Resident sustained an unexplained injury while in care.
Facility staff not fingerprinted.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent visit to deliver findings on above allegations. LPA met with Kim Gi Soung. Shortly after Kim Eunice, Administrator arrived. LPA explained the purpose of the visit.

The investigation consisted of: Interviews and record reviews conducted by DSS Investigation Branch (IB) Investigator and Community Care Licensing (CCL) staff.
Allegations: Staff suffocated residents resulting in death of residents and Resident sustained an unexplained injury while in care. Facility staff not fingerprinted. It was alleged: Staff 1 (S1) suffocated the resident by placing a plastic bag over the Resident 1 (R1) head and taping around the R1’s neck. Injury was observed on R1’s head. Reporting Party (RP) reported that the S1 member also placed a bag over Residents 2 (R2) head as well and placed tape around the neck also murdering R2. RP reported that the residents were found in the bathroom of the facility by Staff 2 (S2). RP also reported that the S1 was not fingerprinted.
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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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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Control Number 28-AS-20240605153844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY HOME CARE FOR ELDERLY	FACILITY NUMBER: 198602403
	VISIT DATE: 09/05/2024

NARRATIVE

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The investigation revealed the following: On 06/24/2023, in the morning, upon arrival at the facility, S2 found two residents R1 and R2 inside the restroom on the floor, unresponsive, and dead upon arrival. S2 immediately called 911. According to the Los Angeles Sheriff’s Department (LASD) S2 observed that “bags were placed over the R1’s and R2’s face by S1. S1 placed bags over the two residents (R1 and R2) heads, and possibly killed them.” Per LASD report before S2 contacting 911, at approximately 7:52 pm. S1 contacted 911 and self-reported the incident. Per S1 911 call, S1 admitted to the dispatcher that S1 just killed two residents / elderly people.

On 6/25/23, Regional Manager Araceli Ramirez and LPA Kimberly Ramirez conducted a health and safety check at the facility and gathered documents pertaining to R1, R2, S1, and S2. During the visit on 06/25/23, it was discovered that S1 was arrested for the murder of two residents of the facility.

On 06/30/23, Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit and an immediate civil penalty of $500 were issued for allowing S1 to work in the facility prior to obtaining a background clearance.
Investigations Branch (IB) investigator conducted the investigation. On 08/08/24 Investigator interviewed the licensee/administrator and S2. Investigator also obtained the L.A. County Sherriff’s report and 911 calls made to the Walnut Sheriff’s Station.

On 8/24/23, Investigator interviewed S1 while in custody. S1 admitted to the murder of R1 and R2 but did not want to go into further details of how the incident occurred. The investigation revealed that S1 started working and residing at the facility on 06/01/23. However, S1’s background clearance did not clear until 06/16/23. Therefore, the licensee allowed S1 to begin working and residing at the facility prior to obtaining a criminal record clearance.

On 10/10/23, Licensing Program Analyst (LPA) Cynthia Chan conducted Case Management visit and another immediate civil penalty of $500 was issued due to neglect.

On 06/05/24 CCLD received a complaint alleging neglect. Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 06/07/2024 regarding the above allegations. LPA Ramirez conducted a Health & Safety Check tour with Administrator and obtained staff and residents’ roster.

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SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240605153844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY HOME CARE FOR ELDERLY	FACILITY NUMBER: 198602403
	VISIT DATE: 09/05/2024

NARRATIVE

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On 09/04/24, Enhanced Civil Penalty (ECP) was issued by Licensing Program Analyst (LPA) Cynthia Chan due to 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 will be $29,500.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED, however deficiencies previously issued during case management and office visits.

Exit interview was conducted and the copy of this report along with appeal rights were provided to Kim Eunice, Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

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