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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 05/19/2021
Date Signed: 05/19/2021 04:28:32 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: 87DATE:
05/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Marty Oh, Monica KimTIME COMPLETED:
04:45 PM
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On 5/19/21, Licensing Program Analysts (LPAs) Sean Haddad, Valarie Cook, and Norman C. Woodridge made an unannounced Plan of Correction inspection to verify correction of deficiencies issued on 5/6/21. LPAs met with Operating Manager (OM) Marty Oh and Staff Monica Kim and explained the reason for today’s inspection. During this inspection, the LPAs observed the following:

Deficiency cited under Title 22 Regulation 87464(f)(1) pertaining to care and supervision has been partially corrected. LPAs were provided training records for 6 staff members for assessing, documenting, and addressing resident needs. An extension has been granted until 6/7/21 for the facility to provide training records for the remaining 11 care staff.

Deficiency cited under Title 22 Regulation 87303(a) pertaining to sanitation issues, feces, diapers, etc. has been cleared. During today’s inspection, LPAs visually confirmed the corrections in affected Rooms 127,120, 121, 119, 118, 105, and 107. Licensee has complied with the terms of the POC by POC due date.

An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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