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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 11:06:52 AM


Document Has Been Signed on 05/06/2022 11:06 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:
10:30 AM
MET WITH:Hyo Sook KimTIME COMPLETED:
11:00 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-NP-20211007132630. LPA met with Administrator (AD) Hyo Sook Kim and explained the reason for today’s inspection.

During the course of the investigation, LPA inspected the facility, interviewed residents, witnesses, and staff, and requested and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) resident file, R1’s Identification and Emergency Information (LIC 601) dated 01/13/20, and R1’s St. Montserrat Hospice Care, Inc. Records dated beginning 01/28/21.

Per interviews with AD Kim, AD Kim stated that they tried to reach R1’s responsible party over 20 times via telephone but the calls were not answered or returned, so they believed R1 had no responsible party. AD Kim stated that prior to AD Kim connecting with R1’s responsible party, R1’s mail had been going to R1’s prior facility, Welcome Christian Home, which was closed, so R1 was not receiving their mail. AD Kim stated that they wanted to become R1’s conservator because they believed R1 had no family, so AD Kim started forwarding R1’s mail to AD Kim’s personal home, including Bank of Hope and Social Security mailings. Per interviews with AD Kim, AD Kim could not provide a reason why AD Kim forwarded the mail to AD Kim’s home instead of the facility. AD Kim stated that after contact was made with R1’s responsible party, AD Kim began forwarding R1’s mail to the facility and turned over all records to R1’s responsible party.

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. 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 11:06 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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87468.1 Personal Rights … (a) Residents … shall have all of the following personal rights: (15) To send and receive unopened correspondence in a prompt manner. This requirement was not met as evidenced by:
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Based on interviews, the licensee did not ensure R1 received unopened correspondence when facility staff forwarded R1’s mail to their personal home, which poses an immediate personal rights risk to persons 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: 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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