306005182-10-8-2021-22-AS-MSTC-C9SNK9-20211217093135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 10/08/2021
Date Signed: 10/08/2021 02:46:12 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
10/07/2021 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211007161727

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: 79	DATE:	10/08/2021
		UNANNOUNCED	TIME BEGAN:	10:18 AM
MET WITH:	Marty Oh		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff are locking residents out of their rooms in memory care

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad to investigate the above-mentioned complaint allegation via tele-visit due to COVID-19 and for precautionary measures. LPA met with Operating Manager (OM) Marty Oh, discussed the purpose of the inspection, and explained the allegation. During the inspection, LPA interviewed OM, toured the memory care unit with OM and conducted a health and safety check on residents, and requested and reviewed resident roster, staff roster, and staff schedule.

The investigation into the allegation that Facility staff are locking residents out of their rooms in memory care revealed the following: On 10/08/21, LPA observed 30 residents in the memory care unit, most of whom were in the common area listening to music, and 1 caregiver. LPA inspected 10 resident rooms and observed 8 of them were locked, leaving the residents locked out of their rooms. During the inspection, OM had the caregiver on duty unlock all resident rooms and LPA confirmed.

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: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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-20211007161727

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: 10/08/2021

NARRATIVE

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Thus, the allegation that Facility staff are locking residents out of their rooms in memory care is determined to be substantiated. An immediate civil penalty is being assessed in the amount of $250 for a repeat violation of the same regulation.

OM stated that there were 2 caregivers on duty, but 1 of them was on break, so there was currently only 1 caregiver providing care and supervision for 30 residents. LPA observed the sole caregiver to be eating lunch while observing the residents in the common area and unable to observe or supervise the hallway containing resident rooms. OM stated that the facility had begun locking residents out of their rooms because residents would wander into the rooms of other residents and upset them. With only 1 or 2 caregivers providing care and supervision to 30 residents, and the facility unable to address the wandering behavior without locking residents out of their rooms, it is clear the facility is not providing enough staff to provide adequate care and supervision to the residents. An immediate civil penalty is being assessed in the amount of $250 for a repeat violation of the same regulation.

During the course of the investigation, CCLD obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. 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. An exit interview was conducted with Facility representative via tele-visit. This report will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to send a signed copy by email. This report was signed electronically at a later time.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20211007161727

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: 10/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/09/2021 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights … (a) Residents … shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee immediately unlocked all affected resident rooms during the inspection. Licensee agrees to train staff not to lock resident rooms in the future and submit proof to LPA within 2 weeks of POC due date
	8 9 10 11 12 13 14	Based on observation and interview, the facility did not provide safe, healthful, and comfortable accommodations to residents in memory care by locking them out of their rooms, which poses an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14	CIVIL PENALTY ASSESSED
Type A 10/09/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met as evidenced by: Based on observation and interview,	1 2 3 4 5 6 7	Licensee states they will immediately ensure 2 staff are present in memory care by providing break coverage and that 1 of the caregivers will conduct regular checks on residents in their rooms.
	8 9 10 11 12 13 14	the facility did not provide enough staff to meet resident needs as 1 or 2 care givers were not able to provide care and supervision to 30 memory care residents or prevent wandering, which poses an immediate health, safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14	Licensee will submit a new memory care procedure and proof of training to LPA within 2 week of POC due date. CIVIL PENALTY ASSESSED

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: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

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