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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 02/01/2022
Date Signed: 02/01/2022 04:57:06 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:MARTY OHFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:340CENSUS: 86DATE:
02/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Erik Doan, Assistant AdministratorTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Manager, Alisa Ortiz, Licensing Program Manager, Armando Lucero, Licensing Program Analyst, Kathrina Chin, along with Orange County Public Health Medical Director, Helene Calvet and RN, Larry Bottoroff, and Ombudsman, Soo Bong Joo made an unannounced health and safety/ COVID-19 positive follow up.

During the visit, LPMs LPA, and Ombudsman toured the facility along with Public Health team and observed all three floors. LPMs, LPA, Public Health and Ombudsman observed resident isolation rooms on the Memory Care Unit and third floor. There are currently approximately 18 positive residents at facility and 8 staff persons. Erik Doan, Assistant Administrator are testing staff and residents once a week for COVID-19. Medical Director provided health and safety mitigation measures to Administrator regarding managing COVID-19 as well prevention/ precautions. Suggestions made included that staff maintaining a supply of PPE outside isolation rooms, to use pulse oximeters to monitor oxygenation of residents and resident/roommate exposed to COVID-19 positive residents should also be quarantined. Dr. Calvet suggested to stop communal dining and activities and staff to check on COVID positive residents three times a day. The facility staff did not report that there are eighteen COVID-19 positive residents and eight staff persons to the licensing agency.

On this day, LPMs and LPA discussed infection control measures with Erik Doan, Assistant Administrator including assuring virtual visitations are made available for COVID-19 positive individuals. Technical Advisory Note were discussed as well as deficiencies cited.

The following deficiencies are cited as per Title 22 of the California Code of Regulation:

An exit interview was conducted and a copy of this report was left with Erik Doan, Assistant Administrator.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 02/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2022
Section Cited

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Reporting Requirements- Each shall furnish to the licensing agency such reports as the Department may require including..occurrences, such as epidemic..which threaten the welfare, safety or health of residents. This requirement was not met as evidenced by : Based on records, observation, and file review, the facility did not
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report eighteen COVID-19 positive residents and eight staff person to the licensing agency. This poses an immediate risk to the health and safety to the residents in care.
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Type A
02/02/2022
Section Cited

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Maintenance & Operations(a) 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 was not met evidenced by : Based on observation, LPMs and LPAs
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observed two vent surrounded by mold. Pictures of the vents with the mold were taken. This poses an immediate risk to the health and safety to the residents 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: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2022
LIC809 (FAS) - (06/04)
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