306005182-8-3-2023-22-AS-MSTC-CUD6TA-20230803210513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 08/03/2023
Date Signed: 08/03/2023 11:11:39 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, 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
06/18/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200618112731

FACILITY NAME:	BOK SENIOR HOTEL		FACILITY NUMBER:	306005182
ADMINISTRATOR:	PAK, HOPE		FACILITY TYPE:	740
ADDRESS:	1100 E WHITTIER BLVD		TELEPHONE:	(714) 529-1697
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	0	CENSUS: 86	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Erik Doan		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff is performing incontinence services in the common area
Staff is not properly cleaning residents while in care
Resident's room is not properly maintained
Resident is left soiled for an extended period of time

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 Erik Doan and explained the reason for today’s inspection. Administrator (AD) Hyo Sook Kim was not present during the inspection.

The investigation into the allegations that staff is performing incontinence services in the common area, staff is not properly cleaning residents while in care, resident's room is not properly maintained, and resident is left soiled for an extended period of time revealed the following: During the course of the investigation, LPAs inspected the facility via tele-visit due to COVID-19 and pre-cautionary measures, interviewed AD and 1 staff, and obtained and reviewed copies of Resident #1’s (R1) Cadence Hospice Medical Records dated 05/27/21.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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 5

Control Number 22-AS-20200618112731

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/04/2023 Section Cited CCR 87468.2(a)(1)	1 2 3 4 5 6 7	87468.2 … Personal Rights … (a) … residents … shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in … personal care and assistance... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility was closed on 02/25/2022.
	8 9 10 11 12 13 14	Based on documents and interviews, the licensee did not ensure 2 residents had privacy when they had their briefs changed in view of other residents, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14
Type A 08/04/2023 Section Cited CCR 87307(a)(3)(D)	1 2 3 4 5 6 7	87307 … (a) ... (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. … the licensee shall assure provision of: (D) Hygiene items of general use such as soap and toilet paper. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility was closed on 02/25/2022.
	8 9 10 11 12 13 14	Based on interviews and observations, the licensee did not ensure wipes, wash cloths, or water were available for the perineal care of 3 residents, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 22-AS-20200618112731

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/04/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility was closed on 02/25/2022.
	8 9 10 11 12 13 14	Based on documents, interviews, and observations, the licensee did not ensure R1’s room was free from a strong odor of urine and R1’s bedding was free from urine, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14
Type A 08/04/2023 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625 Managed Incontinence (b) … the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry.... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility was closed on 02/25/2022.
	8 9 10 11 12 13 14	Based on documents, interviews, and observations, the licensee did not ensure R1 was kept clean and dry leading to R1’s wound deteriorating, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20200618112731

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: 08/03/2023

NARRATIVE

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Witnesses reported that 2 residents were observed having their briefs changed by facility staff in the memory care common area in view of other residents, with 1 of those residents being completely naked from the waist down. LPA interviewed AD who stated they do not remember seeing residents receiving care in common areas or knowing that this was happening. LPA interviewed Staff #1 (S1) who stated that incontinence services and showers were provided in a specific room near the common area, but not in the common area itself. However, review of R1’s Cadence Hospice Medical Records dated 05/27/21 corroborated that hospice staff observed residents receiving care in common areas and that this issue was reported to S1.

Witnesses reported that no wipes, wash cloths, or water were observed to be available for the perineal care of the 2 residents who were observed receiving care in common areas or for R1 and that facility staff attempted to put clean briefs on R1 after a change without providing perineal care. AD stated that the facility did not have enough perineal care supplies at the time. S1 stated that perineal care supplies were stored in one room for memory care and in another room for assisted living and that S1 does not remember any issues regarding perineal care supplies. However, the witness report is corroborated by LPA observations. On 10/09/20 and 02/16/21, LPA observed multiple restrooms lacking soap, toilet paper, paper towels, toilet seat covers, and other toiletries. On 10/06/20, LPA observed that memory care had a limited supply of wipes and advised S1 to remedy the issue so that caregivers do not have to choose between caring for residents and traveling to the laundry/supply room for supplies. On 12/02/19, LPA Marin observed that the supply cart in memory care had few unused briefs and bed liners, no wipes, and that the supply room in memory care had no stock of wipes. LPA Marin also interviewed a staff member who stated they used bed liners to wipe residents during perineal care.

Witnesses reported observing a strong odor of urine in R1’s room and that R1’s bedding was soaked in urine. Review of R1’s Cadence Hospice Medical Records dated 05/27/21 corroborated that hospice staff observed R1’s bedding soiled with urine on 06/14/20. AD conceded that residents’ rooms were not properly maintained at the time. S1 stated that facility staff were always cleaning based on a schedule. However, the witness report is corroborated by LPA observations. On 10/09/20, LPA observed multiple rooms smelling strongly of urine and feces, soiled briefs and incontinence sheets left in resident rooms, and stains on the carpet in resident rooms. On 02/16/21, LPA observed feces left in a toilet and on the floor of a resident bathroom, a bed and chair stained with feces, stained carpet, foul odors, and soiled briefs and incontinence pads left in resident rooms.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20200618112731

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: 08/03/2023

NARRATIVE

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Witnesses reported that R1’s briefs, bedding, and wound dressing were observed to be soaked in urine. Review of R1’s Cadence Hospice Medical Records dated 05/27/21 corroborated that hospice staff observed R1’s briefs, bedding, and/or wound dressing to be soiled with urine and/or feces on 05/21/20, 06/14/20, 06/15/20, 06/17/20, and 06/30/20, that this issue was reported to S1 and facility staff multiple times, and that facility administration and staff were advised multiple times that leaving R1 in soiled briefs for extended periods would cause R1’s wound to deteriorate. R1’s Cadence Hospice Medical Records dated 05/27/21 also state that on 06/12/20 hospice staff observed that R1’s wound had deteriorated because R1 had been left for extended periods in soiled briefs. AD stated that facility staff change residents’ briefs regularly. S1 stated that facility staff have a schedule and a checklist for cleaning residents. However, the witness report is corroborated by LPA observations. On 10/09/20, LPA observed multiple residents left unattended or needing help with facility staff not available, including a resident non-responsive on a bed, 2 residents not wearing pants, and 1 resident with full urine collection bottles that had not been collected by facility staff.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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