Desired Peace Home Care 2

Type of visit: Case Management - Health Checks

On 03/19/2026, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a health and safety check as a result of department receiving a priority 1 complaint. Upon arrival, LPA observed total of two (2) staff, administrator, and two (2) residents watching television in the living room. LPA toured the facility and observed two(2) residents watching television and one (1) resident listening to music in their bedrooms. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. Facility is noted to be clean and in good repair on today's date. Facility is maintained at a comfortable temperature for the clients in care. No deficiencies were cited today. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 19, 2026

Allegation investigated: Facility is in financial distress.

On 10/08/2025 at 3:20PM, Licensing Program Analyst (LPA) T. Syess-Gibson, arrived unannounced to deliver the findings of the allegation above. LPA met with Paul Lam, Administrator, and explained the purpose of the visit. During the investigation LPA reviewed and obtained bills, interviewed witness(W1) staff (S1,S2 and S3). During interviews with S1 and W1, it was revealed that R1 moved into facility on 02/13/2025, R1 wasn’t conserved or had a responsible person (RP), R1 signed admissions agreement and other documents himself upon admission. Continue on LIC9099C Unsubstantiated Continued from LIC9099 R1 was deceased on 02/25/2025, facility issued a refund check made out to R1 instead of W1, W1 did not provide legal documentation to facility to confirm W1 as trustee. During bills review and interviews with S1, S2 and S3 it was revealed there is no evidence of financial distress at this time. LPA spoke with W1 and S1 advising both to meet and take care of the refund matter. W1 agreed to contact S1 and provide trust documentation. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is no preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given to Paul Lam.the state’s words, verbatim · CDSS document, Oct 8, 2025 · control 15-AS-20250827171228

Type of visit: Required - 1 Year

On 09/04/2025 at 10:37AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver, Ana Morales, Caregiver, explained purpose of visit. Rahel Mengesha, House Manager, arrived at 10:48AM. LPA explained the purpose of the visit. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with House Manager including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 109.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and nonskid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2025. Emergency Disaster Plan was last updated on 07/17/2025. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2025. Continued LIC809C. Continued from LIC809. LPA reviewed all five (5) resident records and four (4) staff records, and they were current and complete. LPA also reviewed a sample of medications during visit. LPA requested updated copies of the following documents to be submitted to CCLD by 09/11/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Facility Sketch Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 4, 2025

Allegation investigated: Licensee does not ensure that incidents are reported to authorized representatives.

On 08/21/2025 at 2:52PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegation above. LPA met with Ana Morales, Caregiver, and explained the reason for the visit. Ana contacted Paul Lam, Administrator, via telephone regarding visit. Paul arrived at 3:50PM. During the course of the investigation the LPA interviewed staff, residents, hospice case manager, reviewed and obtained records. Allegation: Licensee does not ensure that incidents are reported to authorized representatives. During interview and record review, it was revealed that Licensee failed to report incidents to CCLD. Continue on LIC9099C.. Substantiated Licensee does not provide adequate supervision resulting in neglect and lack of care to residents. During Interviews with staff it was revealed, licensee has adequate supervision to care for the residents. During interviews with residents, it was revealed that their needs are met, and staff respond to call buttons timely. During record review, it revealed the facility has two (2) staff members, house manager on AM shift and one (1) staff for the night shift. Licensee does not ensure that incontinent residents are kept clean and dry. During interviews with staff, it was revealed that R1 was the only incontinent resident and is changed after each meal and between meals throughout the day. During record review, it was revealed that facility has a changing schedule for incontinent resident. Licensee does not follow hospice care plan. During interviews with staff and hospice social worker, it was revealed staff were trained by the agency on handling R1’s daily needs. During record review it was revealed that R1 is a two person assistance,facility assist hospice assistant and facility does follow R1’s hospice care plan. Licensee does not ensure residents are repositioned which results in developing wounds. During interview with staff, hospice case manager, it was revealed that R1 is the only resident who is bedridden and on hospice that requires repositioning. During record review revealed, R1 is re positioned every four hours daily. Staff will retaliate against residents if they report to Ombudsman and CCLD. During interviews with residents, it was revealed that residents don’t feel they will be retaliated against if they were to report to the ombudsman or CCLD. R2 and R3 also stated during interview, that they both have a great relationship with staff and have never had any conversations with any of the staff regarding reporting to any agency. Continue on LIC9099C Continued from LIC9099C Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted with Paul Lam. A copy of this report provided. Continued from LIC9099 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 with Paul Lam. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Aug 21, 2025 · control 15-AS-20250502150704

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Aug 28, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement is not met as evidence by: Based on interviews and record review, licensee did not comply with section cited above by not submitting incident reports and hospice notification to CCLD which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: Administrator agreed to read 87211(a) and send a self certifying email to CCLD by POC date.

Type of visit: Required - 1 Year

On 09/17/2024 at 11:18 AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver , Irma Martinez explained purpose of visit. Irma spoke with Administrator, Paul Lam via telephone, and explained the purpose of the visit. The Administrator arrived at 11:46AM LPA observed via CCLD website that Administrator Certificate is currently in pending status. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2024. Emergency Disaster Plan was last posted on 08/21/2024. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2024. Continued LIC809C. Continued from LIC809. LPA reviewed all five (5) resident records and four (4) staff records , and they were current and complete. LPA also reviewed a sample of medications during visit. LPA requested updated copies of the following documents to be submitted to CCLD by 09/24/2024. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance · Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 17, 2024

Allegation investigated: Resident sustained injuries due to lack of care from staff

On 2/02/2024 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegation above. LPA met with Administrator, Paul Lam (ADM) and informed him the reason for visit. ADM had to leave during the visit and gave permission for care staff to sign the report. LPA reviewed findings with ADM prior to him leaving. During the course of the investigation LPA inspected the resdient's bedrooms, reviewed R1's file, staff schedule, overnight log and interviewed S1. R1 was admitted to the facility on 11/23/23 from a rehabilitation facility. There was no documentation in R1’s admitting paperwork that he was a fall risk. On the morning of 11/24/23 R1 was found on the floor of his bedroom next to his bed by care staff and a therapist. 911 was called and R1 was sent to Kaiser emergency department for further evaluation. It was discovered that R1 had pneumonia and would remain in the hospital for treatment. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** R1 returned to the facility on 11/28/23. Given R1’s fall risk and nighttime restlessness the facility put in place an overnight staff to monitor R1. Previously the live-in care staff monitored the residents during the overnight shift. LPA observed that there are no cameras in the residents bedrooms. LPA reviewed the overnight log. Overnight staff documented several occasions where R1 was restless or was trying to get out of bed. Staff redirect R1 to lay down and stay with him until he falls back asleep. S1 stated that R1 is currently on hospice. R1’s medications were also recently adjusted, and he is less restless during the night, however overnight staff remain in place. This agency has investigated the complaint alleging resident sustained injuries due to lack of care from staff. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 2, 2024 · control 15-AS-20231129143050

Type of visit: Required - 1 Year

On 10/31/2023 at 12:00 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Paul Lam and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory which 1 may be Bedridden. LPA toured facility with Paul including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 is occupied by the staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms were measured within range 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 08/16/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2023. Report continues on 809 C At 12:30 PM, LPA reviewed 6 of 6 residents records. At 1:10 PM, LPA reviewed 4 of 10 staff records and 4 of 4 have current first aid training and associated to the facility. At 12:12 PM, LPA reviewed a sample of 1 of 6 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/07/2023: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 31, 2023