306005182-5-6-2022-22-AS-MSTC-CHTD3G-20220831022531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 05/06/2022
Date Signed: 05/06/2022 09:28:27 AM

Unsubstantiated

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
04/20/2021 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210420104726

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:	0	CENSUS: 66	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	James Lee		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility has bed bugs

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. 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.

(Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210420104726

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: 05/06/2022

NARRATIVE

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The investigation into the allegation that the facility has bed bugs revealed the following: 2 photographs and 2 videos reviewed show 1 bed bug on residents’ beds at the facility and a resident with what are alleged to be bed bug bites. One of the photograph files is dated 03/24/21 and the metadata for both video files show they were created on 04/16/21. LPA Haddad inspected the facility via tele-visit due to COVID-19 and pre-cautionary measures on 04/28/21. During the inspection, LPA inspected 11 resident rooms and beds and observed no bed bugs. During the inspection, LPA interviewed 2 residents who stated they had not seen bed bugs. LPA interviewed AD who stated that the facility has bed bugs and that the bed bugs were first reported by caregivers 3 weeks earlier. AD also stated the facility identified 10 affected residents who have bug bites and had obtained prescription medications from their doctors, the facility had begun regularly spraying insecticide for the bed bugs 2 weeks earlier themselves and using a pest control company, and that the facility had taken additional measures including changing bedsheets and blankets more frequently and making sure the facility staff were reporting bed bug sightings. 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. However, since LPA’s inspection on 04/28/21, there have been no reports of bed bugs at the facility and LPA has not observed bed bugs on multiple subsequent inspections. While the facility did have bed bugs, the facility took measures to address the bed bugs and care for residents after their discovery, therefore this allegation is unsubstantiated.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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