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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200376
Report Date: 02/21/2025
Date Signed: 02/21/2025 12:41:52 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
11/30/2023 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20231130113925
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: 28DATE:
02/21/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Ugbaja (Ken) Nkemdirm, Administrator TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Questionable death.
INVESTIGATION FINDINGS:
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On 2/21/2025 at 12:10 p.m. Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced visit to deliver the findings for the above complaint allegations. LPA met with Ugbaja (Ken) Nkemdirm, Administrator and explained the purpose of the visit.

Allegation: Questionable death: Unsubstantiated

On 3/27/2024, the Department conduced staff interview, reviewed record of resident (R1) including medical record, death report, key contact information for R1, R1 functional capability assessment and progress notes indicated R1 was able to leave the facility unassisted.

Report Continued on LIC 9099c...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
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-20231130113925
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: 02/21/2025
NARRATIVE
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The preliminary cause of death for R1 was acute cocaine and ethanol intoxication. This facility is a voluntary program, and residents are free to leave the facility under a certain set of rules. R1's physicians report documented that she was able to leave the facility unassisted. On November 28, 2023, R1 initially followed policy when she left the facility but failed to return. Staff followed protocol by calling the resident when she did not show up for her medication and checking in on her periodically. They also filed a missing person’s report with Oakland Police Department within 24 hours of her going missing. Although R1 had a history of substance abuse, she came from a sober living environment. She had only been at the facility for 10 days and did not show signs of substance abuse. R1 case manager (unknown name, not a facility staff member) was responsible for implementing and encouraging R1 to participate in a substance abuse recovery program.

Based on interviews and record reviews conducted, the above allegations are unsubstantiated.



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

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2