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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201331
Report Date: 11/21/2025
Date Signed: 11/21/2025 01:26:56 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
11/19/2025 and conducted by Evaluator Gregory Clark
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251119124536
FACILITY NAME:HOUSE OF PSALMS ASSISTED LIVING FOR SENIORSFACILITY NUMBER:
019201331
ADMINISTRATOR:OGUNDELE, BAMIKOLEFACILITY TYPE:
740
ADDRESS:1525 7TH AVETELEPHONE:
(925) 208-9250
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY:23CENSUS: 19DATE:
11/21/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bamikole Ogundele, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff neglect resident in care
Staff are not distributing resident's medications as prescribed
Staff left resident in soiled diapers and linens for an extended period of time.
INVESTIGATION FINDINGS:
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On 11/21/25 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigationand deliver findings in regard to the allegations above. LPA met with Bamikole Ogundele, Administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed W1 and facility staff and reviewed facility documents. R1 refused to be interviewed.

LPA is well aware of R1’s ongoing refusal to accept care from facility staff, as documented in multiple SIRs submitted by the facility. LPA is also aware that R1 can become physically aggressive toward staff when care is attempted, as evidenced by reports of law enforcement being called to the facility for assistance.

***report continues on LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
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-20251119124536
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: HOUSE OF PSALMS ASSISTED LIVING FOR SENIORS
FACILITY NUMBER: 019201331
VISIT DATE: 11/21/2025
NARRATIVE
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***report continues from LIC9099***

Based on staff interviews, and a review of facility documents, there is no evidence indicating that staff neglected R1 or failed to provide necessary care. Staff consistently reported offering R1 care at regular intervals, including hygiene assistance, repositioning, and medication administration. Medication administration records show that all medications were provided as ordered, very often R1 declined her medications, staff followed proper refusal protocols and notified the appropriate personnel.

Documentation also shows that staff made timely attempts to provide incontinence care to R1 which R1 often refused. When R1 refused care such as changing soiled briefs or bedding, staff documented the refusal, re-approached R1, and offered care again as appropriate. The documentation and interviews demonstrates that staff acted within policy, respected R1’s rights, and did not leave R1 in soiled conditions or without necessary attention for extended periods of time.

This agency has investigated the above complaints. We have found that the complaints 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 conducted, a copy of this report provided.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2