019200376-4-13-2023-15-AS-HHUL-CRXUUU-20230518155405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200376
Report Date: 04/13/2023
Date Signed: 04/13/2023 09:49:35 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, 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
10/10/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221010130713

FACILITY NAME:	GREAT EXPECTATION RESIDENTIAL CARE HOME		FACILITY NUMBER:	019200376
ADMINISTRATOR:	NKEMDIRIM C. UGBAJA		FACILITY TYPE:	735
ADDRESS:	2301 98TH AVENUE		TELEPHONE:	(650) 303-1191
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	32	CENSUS: 24	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nkemdirim (Ken) Ugbaja, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff inappropriately hit residents with fly swatter

INVESTIGATION FINDINGS:

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On 4/13/2023 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Administrator, Nkemdirim (Ken) Ugbaja and informed him the reason for the visit.

During the course of investigation, LPA interviewed 8 residents and complainant. LPA reviewed and obtained a sample of resident's physician's report and emergency information. Based on interview with residents from previous complaint dated 11/18/2021, it was revealed that majority of the residents have witnessed staff hitting residents and sometimes was with a fly swatter.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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 4

Control Number 15-AS-20221010130713

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/14/2023 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation...or other actions of a punitive nature... This requirement is not met as evidence by:	1 2 3 4 5 6 7	Administrator has agreed to retrain all staff on personal rights and submit staff sign-in sheet and training materials to CCLD by POC date.
	8 9 10 11 12 13 14	Based on investigation, licensee did not comply with the section cited above by staff hitting residents with a fly swatter which poses an immediate health and safety risk to the persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
10/10/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221010130713

FACILITY NAME:	GREAT EXPECTATION RESIDENTIAL CARE HOME		FACILITY NUMBER:	019200376
ADMINISTRATOR:	NKEMDIRIM C. UGBAJA		FACILITY TYPE:	735
ADDRESS:	2301 98TH AVENUE		TELEPHONE:	(650) 303-1191
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	32	CENSUS: 24	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nkemdirim (Ken) Ugbaja, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff do not ensure a safe and healthful environment by beating on residents
Staff intimidate residents

INVESTIGATION FINDINGS:

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On 4/13/2023 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Administrator, Nkemdirim (Ken) Ugbaja and informed him the reason for the visit.

During the course of investigation, LPA interviewed 8 residents and complainant. LPA reviewed and obtained a sample of resident's physician's report and emergency information.

Staff do not ensure a safe and healthful environment by beating on residents
Interview with residents reviewed that most of the residents feel safe at the facility. Residents have not witness staff beating on residents.
(Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20221010130713

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: 04/13/2023

NARRATIVE

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Staff intimidate residents
Interview with complainant did not reveal a specific incident where residents were intimidated by staff. Interview with residents revealed that most of the residents doesn't feel intimidated by staff.

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

Exit interview conducted. A copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4