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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602403
Report Date: 10/17/2024
Date Signed: 10/17/2024 10:33:59 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240605153844
FACILITY NAME:HAPPY HOME CARE FOR ELDERLYFACILITY NUMBER:
198602403
ADMINISTRATOR:JUNG HYUN, KIMFACILITY TYPE:
740
ADDRESS:23801 SAPPHIRE CANYON RDTELEPHONE:
(909) 396-1645
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:6CENSUS: 4DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jung "Eunice" Kim, licensee/administratorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff suffocated residents resulting in death of residents.
Resident sustained an unexplained injury while in care.
Facility staff not fingerprinted.
INVESTIGATION FINDINGS:
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On 10/17/24, Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit. The purpose of the visit is to add additional information not included on the reported dated 9/5/24 and to issue an additional deficiency observed during the course of the investigation.

The investigation consisted of: Interviews with staff and the alleged perpetrator and record reviews including but not limited to, police reports and 911 calls conducted by DSS Investigation Branch (IB) Investigator Ryan Miles and Community Care Licensing (CCL) staff.

Allegations: Staff suffocated residents resulting in death of residents. Resident sustained an unexplained injury while in care. Facility staff not fingerprinted. It was alleged: Staff 1 (S1) suffocated the resident by placing a plastic bag over the Resident 1 (R1) head and taping around the R1’s neck. Injury was observed on R1’s head.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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 4
Control Number 28-AS-20240605153844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAPPY HOME CARE FOR ELDERLY
FACILITY NUMBER: 198602403
VISIT DATE: 10/17/2024
NARRATIVE
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Reporting Party (RP) reported that the S1 member also placed a bag over Residents 2 (R2) head as well and placed tape around the neck also murdering R2. RP reported that the residents were found in the bathroom of the facility by Staff 2 (S2). RP also reported that the S1 was not fingerprinted.

The investigation revealed the following:

On 06/24/2023 at approximately 8AM, S2 found two residents R1 and R2 inside the restroom on the floor, unresponsive, and dead upon arrival in the morning. S2 immediately called 911. According to the Los Angeles Sheriff’s Department (LASD), S2 observed that bags were placed over the R1’s and R2’s face by S1. S1 placed bags over the two residents (R1 and R2) heads, and possibly killed them. Per LASD report, S1 contacted 911 at 7:52AM and self-reported the incident before S2 called 911. S1 admitted to the dispatcher that S1 just killed two residents.

On 6/25/23, Regional Manager Araceli Ramirez and LPA Kimberly Ramirez conducted a health and safety check at the facility and gathered documents pertaining to R1, R2, S1, and S2. During the visit on 06/25/23, it was discovered that S1 was arrested for the murder of two residents of the facility.



The investigation revealed that S1 started working and residing at the facility on 06/01/23. However, S1’s background clearance did not clear until 06/16/23. Therefore, the licensee allowed S1 to begin working and residing at the facility prior to obtaining a criminal record clearance. A case management visit was conducted on 6/30/23 by Licensing Program Analyst (LPA) Kimberly Ramirez and a $500 civil penalty was issued for Section 87355(e)(1) Criminal Record Clearance for failure to obtain a required criminal record clearance prior to working and/or residing in the facility. Therefore, the preponderance of evidence standard had been met and the allegation was SUBSTANTIATED.

On 08/08/23, Investigator Miles interviewed the licensee/administrator and S2. Investigator also obtained the L.A. County Sherriff’s report and 911 calls made to the Walnut Sheriff’s Station. On 8/24/23, Investigator interviewed S1 while in custody. S1 admitted to the murder of R1 and R2 but did not want to go into further details of how the incident occurred.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20240605153844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAPPY HOME CARE FOR ELDERLY
FACILITY NUMBER: 198602403
VISIT DATE: 10/17/2024
NARRATIVE
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On 10/10/23, Licensing Program Analyst (LPA) Cynthia Chan conducted a Case Management visit. Based on the interviews conducted and supporting documents provided, there was sufficient evidence to support the allegation of Conduct Inimical. A $500 civil penalty was issued for Section 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities for the facility’s failure to provide the residents in placement with care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Therefore, the preponderance of evidence standard had been met and the allegation was SUBSTANTIATED.

On 06/05/24 CCLD received this complaint alleging the following personal rights violations: Staff suffocated residents resulting in death of residents, resident sustained an unexplained injury while in care and facility staff was not fingerprinted. On 6/7/24, LPA Ramirez conducted a Health & Safety Check tour with the Administrator and obtained staff and residents’ roster.

On 09/04/24 during an office meeting at the Monterey Park Adult and Senior Care Regional Office, Enhanced Civil Penalty (ECP) was issued by Licensing Program Analyst (LPA) Cynthia Chan per Health and Safety Code 1569.49(e) for a violation that the Department determines resulted in the death of two residents in the amount of $30,000 ($15,000 for each death of a resident). However, since an immediate civil penalty of $500 was previously issued on October 10, 2023, the amount of the ECP will be $29,500. Reports were given to the licensee Jung Hyun Kim and originals were signed.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED, however, deficiencies were previously issued during a case management visit on 6/30/23 for not obtaining a criminal record clearance and on 10/10/23 for conduct inimical. The remaining deficiency for personnel requirements will be cited on today’s report.

Exit interview was conducted and the copy of this report along with appeal rights were provided to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240605153844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAPPY HOME CARE FOR ELDERLY
FACILITY NUMBER: 198602403
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2024
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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The licensee shall ensure all employees have related job experience and sufficient training to work with this population. A statement acknowledging this regulation has been read and understood will be submitted to LPA by 10/18/24.
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Staff #1 did not have the competency to provide care to meet the needs of the residents which poses an immediate health, safety, and personal rights to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4