306005182-8-3-2023-22-AS-MSTC-CUD6S7-20230803210329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 08/03/2023
Date Signed: 08/03/2023 11:22:35 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
06/05/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200605173408

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:	10:00 AM
MET WITH:	Erik Doan		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff not meeting resident's needs.

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 allegation. 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 allegation of Staff not meeting resident's needs 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 2 witnesses, and obtained and reviewed copies of R1’s Physician’s Report for Residential Care Facilities for the Elderly (RCFE) (LIC 602A) dated 03/03/17 and R1’s Supportive Hospice Care Medical Records dated from 05/01/20 to 06/24/20.

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)

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Control Number 22-AS-20200605173408

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 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision... 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 documents, the licensee did not ensure R1 received care and supervision when R1 was left unattended, half-clothed, and soiled, which poses an immediate safety and personal rights risk to persons in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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)

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Control Number 22-AS-20200605173408

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 on 06/05/20 Resident #1 (R1) was observed isolated and neglected with their pants down to their ankles, blouse unbuttoned, and that R1 was soiled. LPA Martinez interviewed Witness #1 (W1) who stated that on 06/05/20 they observed R1 laying in bed with their blouse unbuttoned, no bra, pants at their ankles, and diaper half open. Per W1, R1 stated that a facility staff had been helping them but left and had been gone for a “long long time.” W1 then activated R1’s signal system, but after 20 minutes no facility staff had arrived so W1 went to go look for a facility staff for help. Per W1, the facility staff who had been helping R1 was eventually found, stated they had left to find wipes to finish cleaning R1, and was apologetic about forgetting about R1. However, the facility staff had only managed to find small baby wipes and could not find proper wipes. Per W1, the facility did not have wipes available despite wipes having been recently delivered to the facility for use by W1 and R1. LPAs attempted to interview the facility staff identified by W1, but LPAs’ calls were not returned. On 06/09/20 W1 observed R1 soiled again, noted R1 had a “very bad rash” because R1 is not changed when needed, and observed there were no wipes available. LPA Haddad interviewed AD who corroborated that R1 should have had their own incontinence supplies, but was unable to provide any additional information regarding this allegation. LPA Haddad’s interview with Witness #2 (W2) corroborated this allegation. On multiple occasions, W2 observed that R1 was left in soiled diapers for extended periods of time and that there were no staff anywhere to be found to assist or supervise R1 when R1 would return from outings. R1’s Supportive Hospice Care Medical Records dated from 05/01/20 to 06/24/20 (pages 173, 124, 136) state that on 05/02/20, 05/27/20, and 06/24/20, hospice staff observed R1 with a soiled diaper (on one occasion the diaper appeared to be at least 12 hours old) and observed caregivers improperly cleaning R1. This allegation is also corroborated by LPA observations. On 05/12/20, LPAs August and Martinez observed there was only 1 caregiver working in assisted living and interviewed multiple residents who stated the facility needs more staff because residents are left in the dining room a long time after meals before being taken back to their rooms and the 1 caregiver takes a long time to answer calls on the signal system.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation 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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