306005182-3-15-2022-22-AS-MSTC-CHTB7L-20220831004939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 03/15/2022
Date Signed: 03/15/2022 03:21:47 PM

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
12/14/2021 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211214155606

FACILITY NAME:	BOK SENIOR HOTEL		FACILITY NUMBER:	306005182
ADMINISTRATOR:	MARTY OH		FACILITY TYPE:	740
ADDRESS:	1100 E WHITTIER BLVD		TELEPHONE:	(714) 529-1697
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	0	CENSUS: 65	DATE:	03/15/2022
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Hyo Sook Kim		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Resident sustained miultiple fractures while in care and staff did not seek immediate medical attention.
Resident has scabies and had to be treated at the hospital ER

INVESTIGATION FINDINGS:

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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 that Resident sustained multiple fractures while in care and staff did not seek immediate medical attention and Resident has scabies and had to be treated at the hospital ER was conducted by Community Care Licensing Division (CCLD) Investigations Branch (IB) and revealed the following:

During the course of the investigation, LPAs conducted an inspection on 12/17/2021, interviewed staff, and requested and obtained resident records. The IB investigator interviewed 2 witnesses, 5 staff, and obtained and reviewed medical and hospice records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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 22-AS-20211214155606

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: 03/15/2022

NARRATIVE

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It was reported that Resident #1 (R1) sustained multiple fractures while in care and staff did not seek immediate medical attention. However, the investigation did not produce evidence and information to support an allegation of neglect resulting in injury with a fractured elbow to R1. An interview with R1 could not be attempted due to R1 passing away on 12/15/2021. A hospital social worker stated they had no concerns that the injury was caused by lack of care and supervision. Contact was made with R1’s family member who refused to cooperate with the investigation, stated that the facility took good care of R1, and told the IB investigator to “cut it off” with the investigation. Facility staff, including the administrator and the facility registered nurse were interviewed. R1’s case related Norwalk Community Hospital records dated 12/11/2021 and hospice provider medical records dated 11/26/2021 were obtained via subpoena requests. No statements or information supporting the allegation of neglect/lack of care were provided or obtained.

It was reported that R1 had scabies and had to be treated at the hospital ER. Facility staff stated that R1 would scratch themselves, but not excessively as to cause serious concern, and was observed regularly to ensure heath and safety. At the hospital, R1’s diagnosis of scabies was confirmed. However, hospital staff did not suspect neglect or abuse based on R1’s injury or the diagnosis of scabies and that there was nothing else out of the ordinary. Per hospital records, R1 was being treated for scabies at the facility and, after being diagnosed with scabies at the hospital, received additional treatment for scabies there. A scabies outbreak is not currently suspected at the facility. While R1 was diagnosed with scabies, no statements or information obtained indicate neglect or abuse.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations of Resident sustained multiple fractures while in care and staff did not seek immediate medical attention and Resident has scabies and had to be treated at the hospital ER 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: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC9099 (FAS) - (06/04)

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