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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005182
Report Date: 02/16/2021
Date Signed: 02/16/2021 05:01:47 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 HOTELFACILITY NUMBER:
306005182
ADMINISTRATOR:PAK, HOPEFACILITY TYPE:
740
ADDRESS:1100 E WHITTIER BLVDTELEPHONE:
(714) 529-1697
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:340CENSUS: 87DATE:
02/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Monica Kim, Erik DoanTIME COMPLETED:
05:00 PM
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Acting Regional Manager (ARM) Marina Stanic, Acting Licensing Program Manager (ALPM) Valarie Cook, and Licensing Program Analyst (LPA) Sean Haddad made an unannounced case management visit to conduct a health and safety check. ARM, ALPM, and LPA were accompanied by California Department of Public Health (CDPH) Health Facilities Evaluator Nurses (HFEN) Shinhee Kim and Seung Hye Jung. ARM, ALPM, LPA, and HFENs arrived at the facility on 2/16/21 at 9:15 AM and were greeted and granted entry by the receptionist. Administrator (AD) Hope Pak was not present. ARM, ALPM, LPA, and HFENs toured the facility with Operating Manager Monica Kim and Assistant Administrator (AAD) Erik Doan, including memory care, assisted living, laundry room, and kitchen, interviewed residents and staff, and requested and reviewed documents.

AAD represented that all residents and all staff will be COVID tested by 2/23/21 and results will be provided to LPA and the remainder of staff and residents will be vaccinated on 3/5/21.

Due to time constraints, LPA will deliver deficiencies at a later date. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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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