306005182-8-13-2021-22-AS-MSTC-C6R2C2-20210910171600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 08/13/2021
Date Signed: 08/13/2021 03:02:33 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
02/21/2020 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200221062101

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: 85	DATE:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Marty Oh		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Fire Alarm system is defective and generating multiple false alarms
Facility failed to report Fire Alarm malfunction

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.

During the course of the investigation, on 02/24/2020, LPA’s Lydia Martinez and James August interviewed Administrator, 2 Residents, 1 Staff and a Witness, obtained and reviewed Delta Fire Equipment, Inc. Invoice dated 10/28/2019, County of Los Angeles Fire Department Official Inspection Report dated 1/22/2020, Fire Watch Log sheets for February 18 and 19, 2020, undated La Habra Villa Hourly Walk Through for Fire Watch log sheet, Communication Log dated 2/16/2020 and 2/17/2020, and Hilltop Alarms, Inc. Service Order dated 2/17/2020.

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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: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200221062101

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: 08/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/14/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by:	1 2 3 4 5 6 7	Licensee stated the fire alarm system has been repaired and inspected and certified. Licensee provided supporting documentation during today's inspection and LPA confirmed. POC Cleared.
	8 9 10 11 12 13 14	Based on interviews conducted and document reviews, Facility did not ensure Fire Alarm system was in working order. This poses an immediate health and safety risk to the staff and residents in care.	8 9 10 11 12 13 14
Type B 08/27/2021 Section Cited CCR 87211(a)(2)	1 2 3 4 5 6 7	Reporting Requirements – (a) Each licensee shall furnish to the licensing agency such reports ...: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors ... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee reread section 87211 Reporting Requirements during today's inspection and provided LPA with a signed statement of understanding. POC Cleared.
	8 9 10 11 12 13 14	Based on licensing records and Administrator Pak's statement, the facility failed to report the Fire Alarm malfunction to licensing. This poses a potential health and safety risk to residents 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: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200221062101

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: 08/13/2021

NARRATIVE

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Regarding allegation that the Fire Alarm system was defective and generating multiple false alarms, the investigation revealed the following: Administrator Pak, stated the reason Fire Alarm went off was because someone pulled the Fire Alarm on the second-floor East hallway. Resident 1 (R1), Resident 2 (R2) and Staff 1 (S1) confirmed they heard alarm go off in the early morning more than once. On 2/17/2020, Hilltop Alarms, Inc., conducted a service call. Per review of work order, Technician reset pull station at 1st floor East hallway exit, reset Fire alarm panel, and noted on Work Order that all systems returned to normal condition. Interview with Witness 1 (W1), stated they received a call from BOK Senior Hotel on 2/17/2020 because alarms went off. W1 stated Technician went out, reset pull station, reset Fire Alarm panel, and trained staff on how to reset Fire Alarm panel. Review of facility’s Communication Log date 2/16/2020, noted “Fire Alarm went off at 03:00 a.m.…Fire Department called to check if everything is ok…called Hilltop and they said a Technician will get back to us.” Communication Log date 2/17/2020 noted “Fire Alarm went off at 06:00 a.m., was false alarm (Main level E Hall) notified Alarm company (Hilltop)).” On 2/18/2020, LPA Martinez received an email from Los Angeles County Fire Department, Inspector, Institutions Section Steven Chavez, stating Local Fire Station 192 has placed Bok Senior Hotel on Fire Watch and issued violations for multiple false alarms.

Regarding allegation that Facility failed to report Fire alarm malfunction to CCL, the investigation revealed the following: Administrator Pak stated she submitted an Unusual Incident Report to CCL on 2/18/2020 of the 2/17/2020 Fire Alarm incident but did not report the Fire Alarm going off at 03:00 am on 2/16/2020.

Based on records reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegations of Fire Alarm system is defective and generating multiple false alarms and facility failed to report Fire alarm malfunction to CCL are 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.

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SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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