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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 06/03/2021
Date Signed: 06/03/2021 04:53:37 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: 86DATE:
06/03/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Marty OhTIME COMPLETED:
05:15 PM
NARRATIVE
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20200121160538. LPA met with Operating Manager (OM) Marty Oh and explained the reason for today’s inspection.

During the course of the investigation, LPAs Lydia Martinez and Ruth Martinez interviewed Administrator (AD) Hope Pak, 1 witness, 1 staff member, and 6 residents, conducted an on-site visit on 1/23/20, and obtained and reviewed the following records relating to Resident #1 (R1): hospital medical records, hospice medical records, resident file, death certificate, incident report, and work orders. On 1/21/20, a witness reported that R1 had been prescribed a long list of medications, including heart/cholesterol medication, blood pressure medication, and dementia medication, for years but was told by facility staff that R1 was taken off all medications except iron supplements on 12/24/19. Per hospice medical records, the medication was stopped by the order of the hospice doctor once R1 was discharged from hospice in July 2019. The doctor’s order discharging R1 from hospice never made it to the pharmacy and the medication continued to be delivered for R1 and administered to R1 up until December 2019. Thus, the facility continued to administer medications even after they were discontinued by the prescribing doctor resulting in resident hospitalization due to abdominal pain and fecal impaction.

Based on the observations made during the investigation, violations are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/04/2021
Section Cited

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87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall … provide for assistance in obtaining such care, by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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Based on interviews and documents, the licensee did not discontinue R1’s medications until months after the doctor discontinued the medications resulting in resident hospitalization due to abdominal pain and fecal impaction, which poses an immediate health, safety, and personal rights risk to persons 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.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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