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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 06/08/2020
Date Signed: 06/08/2020 03:39:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOTELFACILITY NUMBER:
306005182
ADMINISTRATOR:PAK, HOPEFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:340CENSUS: 93DATE:
06/08/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Hope PakTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez contacted the facility via telephone to commence an unannounced Case Management via telephone due to COVID-19 and pre-cautionary measures. LPA Martinez identified herself to Administrator Hope Pak and explained the purpose of the call was to follow up on an "Immediate Action Required" received by Community Care Licensing (CCL) on 04/20/2020.

CCL received the Confirmation of Removal on 04/24/2020. Staff 1 was removed from the facility on 04/02/2020.

Based on today's phone call with Administrator Hope Pak, LPA verified the individual was not present, employed, nor residing at the facility.

An exit interview was conducted with Administrator Pak and a copy of this report was provided via email. An electronic email read receipt, confirms receiving this document. Administrator agreed to receive the copy of the report and to return a signed copy to LPA via email. Verification of removal is complete.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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