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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 05/06/2022
Date Signed: 05/06/2022 09:46:02 AM


Document Has Been Signed on 05/06/2022 09:46 AM - It Cannot Be Edited

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:HYO SOOK KIMFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:0CENSUS: 66DATE:
05/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:James LeeTIME COMPLETED:
09:45 AM
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-20210420104726. LPA met with facility staff James Lee and explained the reason for today’s inspection. Administrator (AD) Hyo Sook Kim was not present during the inspection.

The investigation into the allegation that the facility has bed bugs revealed the following: During the course of the investigation, LPAs inspected the facility and resident rooms via tele-visit due to COVID-19 and pre-cautionary measures, interviewed witnesses, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, photographs and videos of bed bugs at the facility, pest control records, pharmacy records, and an incident report received by the Orange County Regional Office (OCRO) on 04/29/21.

Per 2 photographs and 2 videos showing bed bugs at the facility and interviews with AD, the facility had bed bugs at least 3 weeks prior to LPA’s inspection on 04/28/21, however based on review of incident reports received at the OCRO, the facility did not report this case of bed bugs to LPA or the OCRO until 04/29/21, the day after LPA’s inspection and approximately 3 weeks after the discovery of bed bugs at the facility.

Based on the interviews conducted and records reviewed during the investigation, violations are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Based on review of the facility's compliance history, which revealed the licensee was cited for the same violation 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 and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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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Document Has Been Signed on 05/06/2022 09:46 AM - It Cannot Be Edited

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: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2022
Section Cited

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports …: (2) Occurrences, such as epidemic outbreaks, … This requirement was not met as evidenced by:
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Based on documents and interviews, the facility did not report the bed bugs within 24 hours and instead waited 3 weeks, which poses an immediate health and safety risk to residents in care.
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CIVIL PENALTY ASSESSED

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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: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
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