306005182-3-26-2021-22-AS-SHAD-BZGRTT-20210326131852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 03/26/2021
Date Signed: 03/26/2021 01:19:08 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 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: 80	DATE:	03/26/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Monica Kim		TIME COMPLETED:	01:00 PM

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	On 3/26/21, Licensing Program Analyst (LPA) Sean Haddad made an unannounced Plan of Correction inspection to verify correction of deficiencies issued during the inspection conducted on 3/8/21 via tele-visit due to COVID-19 and for precautionary measures. LPA met with Operating Manager (OM) Monica Kim and explained the reason for today’s inspection. During this inspection, the LPA observed the following: Type A Violations 1. Deficiency cited under Title 22 Regulation 87303(a) pertaining to maintenance issues, broken lights, exposed screws, etc. has been CLEARED. LPA was provided lists and photos of repairs. During today’s inspection, LPA visually confirmed the corrections in affected Rooms 209 and 233. As of today’s inspection, the POC has been properly cleared. 2. Deficiency cited under Title 22 Regulation 87307(d)(2) pertaining to sanitation issues, feces, diapers, etc. has been CLEARED. LPA was provided lists and photos of repairs. During today’s inspection, LPA visually confirmed the corrections in affected Rooms 116 and 209. As of today’s inspection, the POC has been properly cleared. Type B Violations 1. Deficiency cited under Title 22 Regulation 87468.1(a)(2) pertaining to COVID-19 precautions and masks has been CLEARED. LPA was provided photos of residents wearing masks and socially distancing. During today’s inspection, LPA visually confirmed COVID-19 precautions at the facility. Licensee has complied with the terms of the POC by POC due date. (Continued)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/26/2021

NARRATIVE

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2. Deficiency cited under Title 22 Regulation 87219(d) pertaining to the activity calendar not being posted has been CLEARED. LPA was provided photos of the activity calendar posted in multiple languages. During today’s inspection, LPA visually confirmed the activity calendar was posted. Licensee has complied with the terms of the POC by POC due date.

3. Deficiency cited under Title 22 Regulation 87307(a)(3)(A) pertaining to beds missing bedsprings, bedframes, etc. has been CLEARED. LPA was provided lists and photos of repairs. During today’s inspection, LPA visually confirmed the corrections in affected Rooms 117, 123, 207, 221, and 234. Licensee has complied with the terms of the POC by POC due date.

4. Deficiency cited under Title 22 Regulation 87307(a)(3)(D) pertaining to restrooms missing toilet paper, soap, etc. has NOT been cleared. LPA was provided lists and photos of corrections. However, during today’s inspection, LPA observed multiple bathrooms missing toilet paper, soap, etc., including Rooms 127, 227, 224, 202, 209, 230, 233, 237, and 256. Civil penalties assessed.

5. Deficiency cited under Title 22 Regulation 87555(b)(6) pertaining to the menu not being posted has NOT been cleared. LPA was provided with copies of the menu after the POC due date and only for lunch. During today’s inspection, LPA observed no menu for the Korean option posted and confirmed with OM that no menus for the Korean option were posted. Civil penalties assessed.

6. Deficiency cited under Title 22 Regulation 87211(a)(1)(D) pertaining to the facility not reporting incidents that are required to be reported to CCLD has been CLEARED. LPA was provided incident reports and a statement of understanding from Administrator Hope Pak regarding the reporting requirements of Title 22 Regulation 87211. During today’s inspection, LPA also confirmed OM’s understanding of this regulation. As of today’s inspection, the POC has been properly cleared.

Civil penalties are being assessed. See LIC421FC. An exit interview was conducted with Facility representative via tele-visit. This report as well as Appeal Rights will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to send a signed copy by email.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC809 (FAS) - (06/04)

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