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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 05/06/2022
Date Signed: 05/06/2022 10:29:59 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
10/07/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-NP-20211007132630
FACILITY NAME:BOK SENIOR HOTELFACILITY NUMBER:
306005182
ADMINISTRATOR:PAK, HOPEFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: ZIP CODE:
90631
CAPACITY:0CENSUS: 66DATE:
05/06/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Hyo Sook KimTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Financial Abuse
Facility failed to provide adequate care to a resident resulting to development of pressure injury
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 of financial abuse and the facility failed to provide adequate care to a resident resulting to development of pressure injury revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents, witnesses, and staff, and requested and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) resident file, R1’s Identification and Emergency Information (LIC 601) dated 01/13/20, and R1’s St. Montserrat Hospice Care, Inc. Records dated beginning 01/28/21.
The investigation into the allegation of financial abuse involving R1 revealed the following: Per interviews with AD Kim, AD Kim stated that R1 moved to the facility in January 2020 from another facility called Welcome Christian Home and when R1 moved in, R1 was responsible for themselves and AD Kim believed R1 had no family. (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-NP-20211007132630
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
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R1’s Identification and Emergency Information (LIC 601) dated 01/13/20 states that R1 moved into the facility on 01/13/20 and lists 2 names and phone numbers under “Person(s) Responsible for Financial Affairs, Payment for Care, Legal Guardian, if Any.” AD Kim stated that they tried to reach one of these persons listed, Witness #1 (W1), over 20 times via telephone but W1 never picked up or called back. AD Kim stated that they eventually did make contact with W1 who stated they had not answered AD Kim’s calls because they do not answer calls from unrecognized numbers. AD Kim stated that after contact was made with W1, W1 began managing R1’s affairs and became R1’s responsible party. LPA’s interview with W1 corroborated AD Kim’s statements. AD Kim stated that before they connected with W1, R1’s mail had been going to Welcome Christian Home, which was closed, so R1 was not receiving their mail. AD Kim stated that they wanted to become R1’s conservator because they believed R1 had no family, so AD Kim started forwarding R1’s mail to AD Kim’s personal home, including Bank of Hope and Social Security mailings. Per interviews with AD Kim, AD Kim could not provide a reason why AD Kim forwarded the mail to AD Kim’s home instead of the facility. AD Kim stated that after contact was made with W1, AD Kim began forwarding R1’s mail to the facility. AD Kim stated that, prior to AD Kim connecting with W1, R1 paid their own rent, but AD Kim kept R1’s checkbook. AD Kim stated that the checks were not pre-signed, but that each month when rent was due AD Kim would write out a check to the facility in the rental amount and give it to R1 for signature. Per interview with Facility Staff #1 (S1), S1 stated that the facility does not have pre-signed checks for R1 or any other resident. AD Kim stated that after contact was made with W1, AD Kim gave R1’s checkbook to W1. On 10/11/21, LPA inspected AD Kim's lock box at the facility with AD Kim present, found blank check books for a resident who had recently passed away, but found no other checks and did not find any pre-signed checks in the lock box. S1 stated that AD Kim had recently obtained one of R1’s Bank of Hope bank statements, noticed questionable charges, and reported possible fraud to the bank. AD Kim stated that on 09/02/21 they went to Bank of Hope with R1 and reported some possibly fraudulent checks. AD Kim stated that they do not know anything about these checks other than that they are questionable and that R1 did not know anything about these checks either. AD Kim stated that, based on the check numbers, the checks came from a different checkbook than the one AD Kim kept for R1. AD Kim stated that they discussed these checks with W1, but that W1 did not know anything about these checks either. Based on review of association records, the individuals to whom these checks were written were not associated to this facility. R1’s prior facility, Welcome Christian Home, was closed on 02/06/20. On 10/11/21, LPA conducted a health and safety check on R1 at the facility and noted no health and safety issues. On 10/11/21, LPA interviewed R1 at the facility and R1 reported no issues and R1 confirmed that W1 was R1’s responsible party.
(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-NP-20211007132630
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
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Per interview with W1, W1 corroborated AD Kim’s statements and stated that after AD Kim and W1 connected W1 changed R1’s mailing address to W1’s home address and that AD Kim handed over R1’s checks and passport to W1. W1 stated that W1 is not alleging any wrongdoing or financial abuse by AD Kim or the facility.

The investigation into the allegation that the facility failed to provide adequate care to R1 resulting in the development of a pressure injury revealed the following: Per interviews with AD Kim, AD Kim stated that in January 2021, R1 developed a diaper sore and received care from hospice staff, the sore could have been caused by being in a wheelchair too long, facility caregivers move the residents regularly as part of their duties, and as of LPA’s inspection on 10/11/21 the sore is completely healed. S1 stated that R1 should be receiving 2-3 showers a week and during each shower a body check is conducted. S1 stated that if a sore or ulcer is noticed during a body check, the facility’s procedure is for the caregiver to escalate it to the med tech who would escalate it to the nurse who would escalate it to the doctor for treatment. R1’s St. Montserrat Hospice Care, Inc. Records dated beginning 01/28/21 state that starting 01/28/21 R1 was treated for an existing right hip pressure ulcer using Zinc Oxide 20% Ointment and Triple Antibiotic MS Ointment. R1’s St. Montserrat Hospice Care, Inc. Records dated beginning 01/28/21 also state that on 06/01/21 the Zinc Oxide 20% Ointment was continued and on 06/08/21 R1 was prescribed Silver Sulfadiazine 1% Cream and Augmentin 500mg for an infection. On 10/11/21, LPA conducted a health and safety check on R1 at the facility and noted no health and safety issues. On 10/11/21, LPA interviewed R1 at the facility and R1 reported no issues and stated that the ulcer had completely healed. Per interview with W1, W1 has no knowledge of R1’s pressure injury and has no complaints or concerns about the care R1 received at the facility. Based on the interviews conducted and records reviewed, R1 developed a pressure injury while in care, but the injury was treated regularly and consistently by hospice staff and eventually healed completely. The records reviewed do not note any concern about neglect or abuse with respect to the pressure injury and the interviews conducted did not indicate that any such concerns were reported to or by witnesses and staff.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations of financial abuse and the facility failed to provide adequate care to a resident resulting to development of pressure injury 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