<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 05/06/2022
Date Signed: 05/06/2022 10:11:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210811084742
FACILITY NAME:BOK SENIOR HOTELFACILITY NUMBER:
306005182
ADMINISTRATOR:PAK, HOPEFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:0CENSUS: 66DATE:
05/06/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Hyo Sook KimTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Wrongful death
Resident suffered from malnutrition while in care
Resident suffered from dehydration while in care
Staff did not ensure that resident received medical attention
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator (AD) Hyo Sook Kim and explained the reason for today’s inspection.
The investigation into the allegations of wrongful death, a resident suffered from malnutrition while in care, a resident suffered from dehydration while in care, and staff did not ensure that a resident received medical attention revealed the following: During the course of the investigation, California Department of Social Services (Department) staff conducted an inspection on 08/17/2021, interviewed 5 witnesses and 6 staff, and obtained and reviewed copies of the resident roster, staff roster, resident files, Resident #1’s (R1) medical records, R1’s hospice records, and R1’s death certificate.
The investigation into the allegation of wrongful death revealed the following: R1 resided at BOK Senior Hotel formerly La Habra Villa for approximately 10 years. R1 had Parkinson’s disease and a history of major depression disorder, recurrent, benign prostatic hyperplasia, reflux, osteoarthritis, and other chronic pain.
(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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 3
Control Number 22-AS-20210811084742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BOK SENIOR HOTEL
FACILITY NUMBER: 306005182
VISIT DATE: 05/06/2022
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
R1 was placed on hospice for palliative care on 11/07/2020 and diagnosed by the hospice physician with senile degeneration, anorexia, depression, muscle weakness (functional quadriplegia), and chronic kidney disease (Stage II). R1 signed and dated a Do Not Resuscitate (DNR) form that requested no aggressive medical treatment on 01/27/2020, and Section C of R1’s DNR is checked requesting “No artificial means of nutrition, including feeding tubes.” On 05/13/2021, the hospice physician completed a Hospice Recertification Plan of Care and reported that R1 was terminally ill with a life expectancy of six (6) months or less. The directive of care was DNR and comfort measures. Hospice staff notified and provided updates to R1’s family regarding R1’s declining health. The hospice social worker maintained communication with R1’s family. R1’s family was notified by AD and by hospice staff that R1 was rapidly declining. On 07/11/2021, Witness #1 (W1) visited R1 at the facility, rescinded the DNR, and had R1 transported to a hospital for medical treatment. The hospital physician was made aware that R1 was receiving hospice care. The hospital physician treated R1, but informed R1’s family that any treatment would not change R1’s current condition and offered palliative care until R1’s passing on 07/17/2021. R1’s cause of death was cardiac arrest, hypertension, and sepsis. R1’s health was declining and R1’s life expectancy was terminal. R1 was cared for by the professional staff and the physician of the hospice company along with the staff at the facility. Based on the interviews conducted and records reviewed, R1 passed away at a hospital from terminal conditions while under hospice care and R1’s family was kept aware of R1’s condition, treatment, and decline.
The investigation into the allegations that R1 suffered from malnutrition and dehydration while in care revealed the following: R1 was diagnosed to be terminally ill and had a history of refusing to eat or drink. Facility staff and the hospice social worker reported that they made every attempt to encourage R1 to eat and drink, including sitting with R1, helping R1 drink milk and other beverages through a straw, and using a sponge to keep R1’s lips moist. R1 sometimes became agitated when staff continued to encourage them to eat and drink. The hospice nurse was aware of R1’s condition and R1’s refusal to eat or drink, informed facility staff not to force feed or force R1 to drink water due to possible aspiration, and stated that R1’s refusal of food and water was part of R1 transitioning to end of life. R1 was provided comfort care as their health continued to decline. The hospice physician was aware of R1’s condition and R1’s refusal to eat or drink and requested that hospice staff inform R1’s family that this was the process of R1’s end of life and any aggressive measures to aide R1’s condition would no longer be considered palliative care. Based on the interviews conducted and records reviewed, R1’s refusal to eat or drink was part of R1’s end of life process, R1’s family was made aware of R1’s condition, and facility and hospice staff made every attempt to get R1 to eat and drink while following the instructions from the hospice nurse and physician.
(Continued on 9099C)
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20210811084742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BOK SENIOR HOTEL
FACILITY NUMBER: 306005182
VISIT DATE: 05/06/2022
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
The investigation into the allegation that staff did not ensure that R1 received medical attention revealed the following: R1 had been receiving hospice care off and on due to their medical condition and severe depression since November 2020 after being hospitalized. R1 received services for showers and nutritional needs and the hospice social worker had been treating R1 for depression. R1’s family was provided updates and encouraged to visit R1. R1 contracted scabies and was being treated and R1’s family was made aware of the scabies and treatment plan. R1’s health continued to decline due to being terminally ill and R1 was placed on comfort care by the hospice physician. R1’s family was kept informed that R1 was transitioning to end of life. W1 visited R1 on 07/11/2021 after being informed that R1 was passing away. W1 refused to accept R1’s condition, rescinded the DNR, and requested that R1 be transported to the hospital. The hospital physician advised R1’s family that R1 did not respond well to aggressive IV therapy and treatment. On 07/12/2021, R1’s case was discussed with R1’s family and the decision was made to place R1 on comfort care and R1 was extubated. R1 passed away while in the hospital on comfort care on 07/17/2021. Based on the interviews conducted and records reviewed, R1 was in the process of transitioning to end of life and was provided daily professional care by the hospice company and by the facility caregivers and ultimately continued palliative care while in the hospital until R1 passed away on 07/17/2021.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations of wrongful death, a resident suffered from malnutrition while in care, a resident suffered from dehydration while in care, and staff did not ensure that a resident received medical attention occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3