306005182-10-9-2020-22-AS-SHAD-BU93SN-20201009183037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 10/09/2020
Date Signed: 10/09/2020 06:30:42 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 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:	340	CENSUS: 80	DATE:	10/09/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Monica Kim, Erik Doan		TIME COMPLETED:	06:45 PM

NARRATIVE

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Licensing Program Manager (LPM) Marina Stanic and Licensing Program Analysts (LPAs) Sean Haddad and Lydia Martinez made an unannounced case management visit to conduct a health and safety check. LPM and LPAs arrived at Facility on 10/9/20 at 3:00 pm and were greeted and granted entry by Monica Kim, Operating Manager. Administrator (AD) Hope Pak was not present. LPM and LPAs toured the entire Facility, including memory care, assisted living, laundry room, and kitchen.

Monica and Assistant Administrator Erik Doan confirmed the signal system is not functioning for first and third floors. The call system works on the second floor, but no Facility staff was present at the reception desk to receive the calls. LPAs tested the signal system on all floors and found that no Facility staff responded. LPAs observed that the menu was not followed and dinner was served cold. LPAs observed no sanitizer throughout the Facility other than one dispenser at the reception desk. LPAs observed the 2 restrooms designated for public, staff, and resident use had no soap, paper towels, or toilet seat covers. These restrooms were first observed to be locked with a sign indicating they were not in use, but were later unlocked and made available. LPAs observed many resident private bathrooms missing soap, towels, and toilet paper. Due to time constraints, LPAs will deliver deficiencies at a later date.

LPAs requested personnel files, but they were not available.

Exit interview conducted. Assisted Administrator Erik Doan indicated he understood the report and will begin working on corrections immediately. Copy of report provided.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

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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