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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200376
Report Date: 12/04/2023
Date Signed: 12/04/2023 01:44:41 PM

Document Has Been Signed on 12/04/2023 01:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOMEFACILITY NUMBER:
019200376
ADMINISTRATOR:NKEMDIRIM C. UGBAJAFACILITY TYPE:
735
ADDRESS:2301 98TH AVENUETELEPHONE:
(650) 303-1191
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 32CENSUS: 27DATE:
12/04/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nkemidirim "Ken" Ugbaja, AdministratorTIME COMPLETED:
02:00 PM
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On 12/4/2023 starting at 12:00 PM, Licensing Program Analysts (LPA) K. Nguyen conducted a Health & Safety inspection as a result of a priority 1 complaint. LPA met with Nkemidirim "Ken" Ugbaja, Administrator.

LPA toured facility with Nkemidirim "Ken" Ugbaja, Administrator including but not limited to the Clients bedroom total of 8 bedrooms, 6 bathrooms, common areas, kitchen, and outdoor area. Hot water temperature was measured at 115 degrees F in the client’s bathroom. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Refrigerator temperature was observed at 35 degrees F. Resident's medications were kept locked in the med room. Smoke detectors are interconnected with the sprinkler system. Carbon monoxide detector was observed. Fire extinguisher was observed to be full and last serviced on 4/27/23. There are no accessible bodies of water observed. Indoor and outdoor passageways are free of obstruction. Facility appear to be safe and there are no imminent health/safety concerns on today's date.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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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