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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200376
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:25:19 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2022 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20220718145529
FACILITY NAME:GREAT EXPECTATION RESIDENTIAL CARE HOMEFACILITY NUMBER:
019200376
ADMINISTRATOR:NKEMDIRIM C. UGBAJAFACILITY TYPE:
735
ADDRESS:2301 98TH AVENUETELEPHONE:
(650) 303-1191
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY:32CENSUS: 26DATE:
07/22/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Casey Ubaja, Manager on Duty
Chika Ubaja, Licensee		TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility did not allow resident to call the police
INVESTIGATION FINDINGS:
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On 07/22/22 at 11:20AM, Licensing Program Analysts (LPAs) D Panlilio and L Holmes conducted an unannounced complaint visit, met with manager on duty (S1), spoke to licensee on the phone, gathered information relevant to the allegation and delivered investigation finding. LPAs explained the purpose of the visit with S1 and licensee.

Allegation: Facility did not allow resident to call the police
Investigation Finding: UNSUBSTANTIATED
During investigation records were reviewed and the Licensee, S1 & W1 were interviewed. Review of records show that C1 experienced a physical assault by a roommate at the facility on 07/12/22 resulting in hospitalization. Licensee stated that a physical assault happened between C1 and C2 at 2AM on 07/12/22. Staff on night duty immediately separated and redirected both clients to ensure their safety.

Continued on next page, LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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 15-AS-20220718145529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GREAT EXPECTATION RESIDENTIAL CARE HOME
FACILITY NUMBER: 019200376
VISIT DATE: 07/22/2022
NARRATIVE
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S1 denied that staff did not allow C1 to call the police because before night staff can call the police, C1 already called the police right away. Staff was not given the chance to call the police. Police arrived around 3AM and took C1 to the hospital for treatment and evaluation. Licensee stated that both clients have signed a contract to not fight and follow the house rules. They are now residing in separate bedrooms and are constantly monitored by staff.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2