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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005182
Report Date: 05/06/2022
Date Signed: 05/06/2022 11:19:55 AM

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
03/11/2020 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200311160613
FACILITY NAME:BOK SENIOR HOTELFACILITY NUMBER:
306005182
ADMINISTRATOR:PAK, HOPEFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:0CENSUS: 66DATE:
05/06/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Hyo Sook KimTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff did not supply adequate toiletries
Staff are not providing adequate food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sean Haddad made an unannounced visit to this facility to deliver findings into the above allegations. LPA met Administrator (AD) Hyo Sook Kim and discussed allegations.
Based on statements made by three witnesses and LPA observations the two restrooms located near the resident dining room were observed to be without paper towels or toilet paper on multiple occasions. These restrooms are accessible and used by residents in care. Based on review of facility menu dated March 1, 2020 to March 7, 2020, witness observations and LPA observations, facility food was small in portions, lacked quality and sandwiches were served for dinner every night. Facility did not provide dietician consult information.
The preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8) are being cited on the attached 9099D. 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. Exit interview conducted, and a copy of this report was left at the facility.
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20200311160613
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: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2022
Section Cited
CCR
87555(a)
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87555(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances .... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by:
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The facility was closed on 02/25/2022.
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Based on documents, observations, and interviews, the facility did not ensure the quantity, quality, and variety of food provided to residents, which poses an immediate health and personal rights risk to residents in care.
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CIVIL PENALTY ASSESSED
Type A
05/07/2022
Section Cited
CCR
87307(a)(3)(D)
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(a)Living accommodations and grounds shall be related to the facility's function…(3)Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident…(D)Hygiene items of general use such as soap and toilet paper. This requirement was not met as evidenced by:
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The facility was closed on 02/25/2022.
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Based on observations and interviews, the facility did not ensure the two restrooms located near the resident dining room, accessible and used by residents, had paper towels and toilet paper on multiple occasions, which poses an immediate health and personal rights risk to residents 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
LIC9099 (FAS) - (06/04)
Page: 2 of 2