306005182-6-21-2021-22-AS-MSTC-C65TWC-20210822150520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 06/21/2021
Date Signed: 06/21/2021 03:46:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200211162826

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: 86	DATE:	06/21/2021
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Mary Oh		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff yells at client
Resident's rent illegally increased
Staff did not provide clean and sanitary environment
Staff failed to meet resident's hygiene needs

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Operating Manager (OM) Marty Oh and explained the reason for today’s inspection.
The investigation into allegations that Staff yells at client, Resident's rent illegally increased, Staff did not provide clean and sanitary environment, and Staff failed to meet resident's hygiene needs revealed the following:
During the course of the investigation, Licensing Program Analysts (LPAs) Lydia Martinez and James August conducted an on-site inspection on 2/12/20, toured the facility, interviewed Administrator (AD) Hope Pak, 3 witnesses, and 4 residents, and obtained and reviewed copies of resident files.
On 1/17/20, a witness reported that they were at the facility and witnessed AD yelling at Resident #1 (R1). Due to the yelling, the witness felt the need to intervene and asked that AD remain professional. On 2/12/20, LPAs interviewed R1 who stated the facility staff yell at each other and residents. R1 felt that Staff #1 (S1) is “very hostile” and reported that S1 yells at R1 and other residents. (Page 1)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

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 5

Control Number 22-AS-20200211162826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/05/2021 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) … residents … shall have all of the following personal rights: (8) To be free from … humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee states they will train all staff to avoid yelling at and treating residents and other staff with hostility and submit proof of training to LPA by POC due date
	8 9 10 11 12 13 14	Based on interviews, the licensee allowed staff to yell at and treat residents with hostility, which poses a potential personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 07/05/2021 Section Cited CCR 87507(f)	1 2 3 4 5 6 7	87507 Admission Agreements. (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee states they will update their 60-day notice to include sections for the reasons for the rental increase and a general summary of the additional costs that led to the increase, submit a copy to LPA by POC due date, and complete these new sections when providing future notices to residents
	8 9 10 11 12 13 14	Based on documents, the licensee did not comply with the admission agreement as the 60-day notice did not provide the reasons or a general summary of additional costs that led to the rent increase, which poses a potential personal rights risk to persons in care.	8 9 10 11 12 13 14

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 Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 22-AS-20200211162826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/22/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	During today's inspection, LPA confirmed corrections in memory care and public bathrooms. Licensee agreed to provide cleaning schedule to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews and photographs, the licensee did not ensure resident rooms, bathrooms, and common bathrooms were clean and sanitary, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14
Type A 06/22/2021 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464 Basic Services. (f) Basic services shall at a minimum include: (4) Personal assistance and care … with those activities of daily living such as dressing, eating, bathing… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	During today's inspection, LPA confirmed correction by reviewing shower schedule and detailed shower logs showing date, care giver name, resident name, shower/bath/refused, and skin/facial hair check as well as other information.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not ensure residents were offered showers and other hygiene services they required, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14

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 Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20200211162826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/21/2021

NARRATIVE

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For example, S1 yells at R1 and other residents if they take too long in the shower or ask questions. R1 also reported Staff #2 (S2) yells at R1 and other residents. On 2/12/20, LPAs interviewed another resident who corroborated that S2 “always” raises their voice at residents and S1 yells at residents. On 1/28/21, LPAs interviewed S2 who denied yelling at residents and stated if they raise their voice it is due to resident hearing issues. Notwithstanding S2’s statements, witnesses and residents corroborate that other facility staff yell at residents in a hostile manner, thereby creating a hostile and intimidating environment, and thus this allegation is substantiated.
On 2/11/20, a witness reported an issue with R1’s rent being increased. Per the witness, a facility invoice dated 1/26/20, and R1’s admission agreement dated 6/29/19, R1’s rent was $2,800 per month, with R1 paying $1,600 and the remaining $1,200 to be paid via government subsidy once the subsidy is approved. Per a 60-Day Notice to Change the Terms of Your Rental Agreement, dated 1/15/20 and effective 4/1/20, R1’s rent was raised from $1,600 to $3,100 per month, an increase of $1,500, but no reason for the increase was provided in the notice. On 1/26/21, LPAs interviewed AD who stated R1 paid via check, the facility does not know where R1’s rent money came from, R1 moved out during the 60-day notice period, the government subsidy was never paid to the facility, and up until R1 moved out R1’s responsible party was still waiting on a response from the government agency regarding the subsidy. The 60-day notice did not indicate the reason for the rent increase or a general summary of additional costs that led to the increase as required by regulations and the admission agreement, which mirrors applicable regulations and states “In the event of a rate increase, we will include with the notice of the increase the reasons for the increase and a general summary of the additional costs that led to the increase” on pages 7-8 , thus this allegation is substantiated.
On 1/17/20, a witness reported that they were at the facility and observed feces in R1’s room, bathroom, and the hallway bathroom. On 2/12/20, LPAs interviewed R1 who stated that R1’s linens are not changed regularly, the facility and its bathrooms are not cleaned regularly, and the facility staff take an unreasonable amount of time to clean spills or stains after R1 requests cleaning. R1 provided LPAs with pictures dated between 1/17 and 2/6/20 showing: stains on R1’s carpet, stains on R1’s bed, and stains and feces on R1’s toilet. On 2/12/20, another witness reported that while they were recently at the facility they observed feces on the floor of the common bathrooms and that the common bathrooms lacked paper towels or toilet paper. This witness reported seeing the common bathrooms in this state multiple times. Thus, the facility did not provide a clean and sanitary environment and this allegation is substantiated. An immediate civil penalty is being assessed in the amount of $250 for a repeat violation of the same citation previously issued on 03/08/2021. The civil penalty shall be assessed until the violation is corrected. (Page 2)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20200211162826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/21/2021

NARRATIVE

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On 2/11/20, a witness reported R1 was being bathed at most once a week and was not receiving a full bathing. On 2/12/20, LPAs interviewed R1 who stated they were last bathed approximately a month prior on 1/17/20. Per R1’s Needs and Services Plan dated 10/30/19 and the facility’s bathing schedules, R1 was to receive 2 showers a week. Per the shower logs, R1 refused showers on 12/8/19, 1/9/20, and 3/19/20, was scheduled for a shower on 2/13/20, and received a shower on 2/28/20 and 3/24/20. This documentation does not demonstrate that R1 was offered 2 showers a week and 2 out of 2 residents and 1 out of 1 witnesses interviewed by LPAs corroborated that the facility does not provide the required number of showers to residents. In addition, a resident’s family member reported that the resident’s diapers are not being changed and the resident is often in wet diapers. Thus, multiple residents and witnesses corroborate the fact that the facility staff are failing to meet residents’ hygiene needs and this allegation is substantiated. An immediate civil penalty is being assessed in the amount of $250 for a repeat violation of the same citation previously issued on 03/08/2021. The civil penalty shall be assessed until the violation is corrected.
Based on records reviewed, observations and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8) are being cited on the attached 9099D. Based on review of the facility's compliance history, which revealed the licensee was cited for the same violations within the last 12 months, civil penalties in the amount of $250 per repeat violation are being assessed. Civil penalties of $100 per day, per violation will accrue until the deficiencies are corrected. See LIC421FC. Exit interview was conducted and a copy of this report as well as appeal rights was left at the facility. (Page 3)

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC9099 (FAS) - (06/04)

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