306005182-12-3-2021-22-AS-AORZ-CE3UWE-20220503155637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 12/03/2021
Date Signed: 12/03/2021 01:14:55 PM

Substantiated

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
11/23/2021 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211123171003

FACILITY NAME:	BOK SENIOR HOTEL		FACILITY NUMBER:	306005182
ADMINISTRATOR:	MARTY OH		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:	12/03/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Marty Oh, Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Bedridden residents being retained without a bedridden fire clearance.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Kathrina Chin for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Marty Oh, Administrator and explained the reason for today’s inspection.

The investigation into the allegation that Bedridden residents being retained without a bedridden fire clearance:

During the course of the investigation, LPAs, Kathrina Chin and Jerome Haley conducted an inspection on 12/1/2021, interviewed residents and staff. Four residents out of eleven residents interviewed were unable to reposition and turn without assistance. The facility does not have a bedridden fire clearance in order to accept or retain residents who are bedridden. Physicians report for R1, R2, R2, R4 were reviewed. According to Mr. Oh, all four residents are not on hospice care. (Continued on LIC 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

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-20211123171003

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: 12/03/2021

NARRATIVE

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Based on the information obtained during the course of the investigation through interviews, observations and record review, a preponderance that was established to substantiate the allegation.

See LIC 9099D for cited deficiencies per Title 22, Division 6 of the California Code of Regulations

An LIC 421IM Immediate Civil Penalty was assessed in the amount of $500.

An exit was conducted with Marty Oh, Administrator and Erik Doan, Assistant Administrator and LPA Chin discussed and read this report. A copy of this report will be provided along with the appeal rights.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20211123171003

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: 12/03/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/06/2021 Section Cited CCR 87202(a)(2)	1 2 3 4 5 6 7	Fire Clearance. All facilities shall maintain a fire clearance. Prior to accepting persons over 65 years of age and/or nonambulatory persons the licensee shall notify the licensing agency and obtain an appropriate fire clearance. .. fire department, or .. providing fire protection services.. Or (2)Bedridden persons. This requirement is not met as evidenced by: based on observation, and fire clearance.	1 2 3 4 5 6 7	Licensee to ensure it maintains an appropriate fire clearance approved by the city, county, or city and county fire department, or district...or the State Fire Marshal if it accepts or retains a bedridden resident. The facility does not currently have a bedridden fire clearance.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: based on resident record review the licensee failed to ensure it did not accept/retain a bedridden residents, residents #1, 2, 3 & 4 are unable to reposition and are bedridden. The facility does not have a bedridden fire clearance. This poses an immediate risk to the health & safety of residents in care.	8 9 10 11 12 13 14	Marty Oh, Administrator and Erik Doan, Assistant Administrator will make a decision on 12/6/2021 along with the current Licensee if they will relocate or apply for a bedridden fire clearance.
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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 Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

LIC9099 (FAS) - (06/04)

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