306005182-5-6-2021-22-AS-MSTC-C4NRRU-20210706131544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 05/06/2021
Date Signed: 05/06/2021 05:14:06 PM

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
01/29/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200129081330

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:	340	CENSUS: 85	DATE:	05/06/2021
		UNANNOUNCED	TIME BEGAN:	04:25 PM
MET WITH:	Operating Manager (OM) Marty Oh, Monica Kim		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1) Neglect/Lack of Care & Supervision - Resident sustained unexplained injuries while in care
2) Facility staff failed to seek medical attention for the resident in a timely manner
3) Facility is unsanitary
4) Facility staff are not properly trained
5) Facility staff failed to meet resident’s needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sean Haddad contacted the facility via tele-visit due to COVID-19 precautionary measures to deliver findings for the investigation into the above identified complaint allegations. LPA spoke with Operating Manager (OM) Marty Oh and Monica Kim and explained the purpose of the telephone call.

The investigation into allegations that Neglect/Lack of Care & Supervision - Resident sustained unexplained injuries while in care and Facility staff failed to seek medical attention for the resident in a timely manner was conducted by Community Care Licensing Investigations Branch (IB). The investigation into allegations that 3) Facility is unsanitary, Facility staff are not properly trained, and Facility staff failed to meet resident’s needs was conducted by Regional Office LPAs. The investigations revealed the following.

(Page 1)

Substantiated

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: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

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 6

Control Number 22-AS-20200129081330

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: 05/06/2021

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

During the investigation, interviews were conducted with facility Administrator and witnesses. Additionally, copies of St. Jude Hospital Medical records dated 1/26/2020 for Resident 1 (R1), Communication Log Report (1/25/2020-1/26/2020) for NOC Shift, La Habra Police Incident Report #20-003284, Incident Report Dated 1/26/20, and Death Report for R1 were obtained and reviewed.

Per St. Jude Hospital Medical records dated 1/26/2020, Resident 1 (R1) is an 89-year-old diagnosed with dementia residing at facility who presented to the Emergency Room on 1/26/20 with altered mental status and fever. R1 was noted to have abrasions to left eyelid, scrapes on both cheeks, and reddened area on both cheeks. Attending physician reported that a resident at the facility called 9-1-1 because R1 was calling for help. Review of Communication Log Report (1/25/2020-1/26/2020) for NOC Shift revealed R1’s injuries were not logged by Facility staff. In addition, interviews with Staff 1 (S1) and Administrator (AD) Hope Pak revealed Facility did not have an explanation for how R1 received these injuries. Based on review of documents and interviews, LPAs determined R1 sustained unexplained injuries while in care.

Per Communication Report (1/25/2020-1/26/2020) for NOC Shift, overnight staff S1 responsible for R1 checked on R1 at 12:45 a.m. and noted R1 was in hallway naked, S1 checked on R1 at 3:05 a.m. and noted R1 was walking around room very confused, and S1 checked on R1 at 5:25 a.m. and observed R1 sitting next to bed very confused and noted R1 was not at R1’s baseline the whole night and determined R1 needed emergency medical attention. Per interview with S1, S1 immediately explained the situation to AD. AD instructed S1 that it was not an emergency and just to call transport ambulance. S1 informed AD that the end of her shift, 6:30 a.m., was approaching. AD instructed S1 not to gather R1’s documents and information to call the ambulance if it would cause her to go over hours and accrue overtime hours. S1 confirmed to AD that she did not have time to call the ambulance because they are understaffed. Per interview with AD, AD stated she advised S1 to order a transport ambulance as opposed to calling 9-1-1 because at that time AD was only aware of increased confusion and nothing was reported to her about R1 having cuts or bruises. AD stated the last overnight check was recorded at 5:25 a.m. and did not indicate any face wounds.

After speaking with AD, S1 left a note for the next shift to call an ambulance for R1. The next shift, which started at 6:30 a.m., did not get the message. R1 was not checked on again until after 9:00 a.m. when Resident 2 (R2) and Resident 3 (R3) checked on R1 after R1 did not show up for breakfast and they heard R1 calling for help. (Page 2)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 22-AS-20200129081330

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: 05/06/2021

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

Facility staff still did not call for emergency medical attention at this point. Facility manager Mann Park called Lynch Ambulance for a non-emergency transport even though R1 had visible injuries to R1’s head and face. R3 called 9-1-1 when staff would not. By the time the Fire Department arrived, it had been 4 hours since S1 first realized R1 needed emergency medical attention. Based on review of documents and interviews, LPAs determined Facility staff failed to seek medical attention for R1 in a timely manner.

Per report from Los Angeles County Fire Department, the Fire Department responded to the Facility on 1/26/20 at 9:21 a.m. and reported observing feces all over R1’s room and soiled undergarments in the bathroom. LPAs’ interview with Witness 1 (W1) revealed W1 has since moved R2 out of the facility because of the unsanitary conditions, including dirty bathrooms that are never stocked with toilet paper, paper towels, or soap. W1’s statements were corroborated by LPAs’ direct observations. On 12/30/20, LPAs observed feces on wall of activity room. On 1/09/20, LPAs noted a strong foul urine odor throughout memory care. On 1/13/20, LPA Marin observed the following: loose clothes over the chair and a soaked diaper on the floor in Room 304; dark brown debris in between bed sheets, dark brown debris and strain marks on carpet in Room 307; dark gray carpet with multiple light to dark brown stains Room 311; carpet with multiple dark gray stains in Room 312; and dark gray stains in toilet bowl, shower strainer out of place, beds not made, debris on the floor, multiple stains in the carpet, and dark brown debris in between sheets in Room 318; and a strong offending odor in the hallway on third floor memory care. On 1/23/20, LPAs Lydia Martinez and Ruth Martinez observed a carpet with feces and a wall with feces. On 1/30/20, LPAs Martinez and August observed urine on the floor in the main Memory Care bathroom, a toilet with feces on the lid in resident room 313. LPAs also noted most resident rooms in Memory Care had a foul smell and observed at a minimum 15 beds in Memory Care had soiled bed pads on the beds. Based on interviews and observation, LPAs determined Facility is unsanitary.

Per report from Fire Department, Fire Department Personnel responded to the Facility on 1/26/20 at 9:21 a.m. and observed numerous injuries to R1, including abrasions to left eyelid, scrapes on both cheeks, and reddened area on both cheeks, along with altered mental status. The Fire Department reported that no staff member at Facility was able to provide any information about the incident involving R1, how R1 sustained their injuries, R1’s baseline mental status, or how long R1 had been in distress. A caregiver met Fire Department Personnel but could provide no information about R1, including whether R1 was ambulatory and what R1’s normal status was.
(Page 3)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 22-AS-20200129081330

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: 05/06/2021

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

10 minutes later, a med tech met Fire Department Personnel but was similarly unable to provide any information on R1, including medical history and whether R1 had any allergies. LPAs’ interview with AD confirmed that at least 2 facility staff were unable to provide Fire Department Personnel with important information they urgently needed to assess, triage, and provide medical aid to R1.

Facility staff knew R1 needed emergency medical attention since at least 5:25 a.m. Per interview, W2 stated that R1 and R2 told W2 that they heard R1 screaming for help for 45 minutes and no staff came to assist R1. When the Fire Department arrived at 9:21 a.m., it had been 4 hours since facility staff knew R1 needed emergency medical attention. During that 4-hour window, facility staff did not check on R1, provide R1 necessary aid or assistance, or ensure R1 received necessary medical treatment. The Fire Department reported it was obvious that R1 was not receiving proper care. Per training records, Facility staff involved received mandated training. However, based on review of records and interviews, LPAs determined Facility staff were not properly trained, ignored R1’s calls for help and were not able to competently assess R1’s condition, provide aid or assistance to R1, relay information between shifts, or provide urgent information to Fire Department Personnel. For these same reasons, LPAs determined Facility staff failed to meet resident needs.

During the course of the investigation, CCLD 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. Based on review of the facility's compliance history, which revealed the licensee was cited for the same violations within the last 12 months, civil penalties in the amount of $250 per repeat violation are being assessed. Civil penalties of $100 per day, per violation will accrue until the deficiencies are corrected. See LIC421FC. A civil penalty is pending determination, per H&S Code section 1569.49(e).

An exit interview was conducted with facility representative via tele-visit a copy of the report along with appeal rights was sent via email and an electronic email read receipt confirms receiving of the report. Facility representative agrees to review, agrees to send the signed report via email.

(Page 4)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 22-AS-20200129081330

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: 05/06/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 05/07/2021 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464(f)(1) - Basic Services. Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This Requirement is not being met as evidenced by:	1 2 3 4 5 6 7	Licensee states they will ensure staff are properly trained in assessing, documenting, and addressing resident needs and changes in resident needs.
	8 9 10 11 12 13 14	Interviews and documents revealed that at 5:25 a.m., staff knew of R1's altered mental status, but neglected to check on R1 again until 9:00 a.m. after R1 sustained injuries which poses an immediate health, safety, and/or personal rights risk to persons in care.	8 9 10 11 12 13 14
Request Denied Type A 05/07/2021 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	87465(g) - Incidental Medical and Dental Care Services. 9-1-1 shall be telephoned immediately if an injury or other circumstance has resulted in an imminent threat to a resident’s health, including an apparent life-threatening medical crisis. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee states they will ensure staff are properly trained on when to call 911.
	8 9 10 11 12 13 14	Interviews conducted and documents reviewed revealed that Facility staff were aware R1 needed emergency medical attention and had visible injuries to the head and face, but licensee failed to call 911. This poses an immediate health, safety, and/or 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: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 22-AS-20200129081330

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: 05/06/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/07/2021 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: Fire Department report and LPA interview and observation revealed feces all over R1’s room and soiled undergarments in bathroom,	1 2 3 4 5 6 7	Licensee states they will ensure bathrooms are stocked with toilet paper, towels or paper towels, and soap, and will ensure resident rooms and memory care are free from feces, soiled diapers/undergarments, unsanitary stains, and offending odors.
	8 9 10 11 12 13 14	unsanitary conditions including dirty bathrooms lacking basic sanitary supplies, and soiled diapers, stained sheets and carpet, and foul odors in resident rooms and memory care. This poses an immediate health, safety, and/or personal rights risk to persons in care.	8 9 10 11 12 13 14
Request Denied Type A 05/07/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a): Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Interviews conducted and documents reviewed revealed that Facility staff ignored R1’s calls for help	1 2 3 4 5 6 7	Licensee states they will create processes for and conduct training on emergency medical situations, including assessing residents’ status and needs, having sufficient staff to meet residents’ needs and relaying this information between shifts and to emergency personnel.
	8 9 10 11 12 13 14	and were not able to competently assess R1’s condition, provide aid or assistance to R1, relay information between shifts, or provide urgent information to Fire Department Personnel, which poses an immediate health, safety, and/or 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: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021

LIC9099 (FAS) - (06/04)

Page: 6 of 6