Desired Peace Home Care

Type of visit: Required - 1 Year

On 09/09/2026 at 10:35AM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Jean Tancioco, Caregiver, LPA explained the purpose of visit. The Administrator arrived at approximately 10:55AM and LPA explained the purpose of visit. Facility has census of 6. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator Paul Lam including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms, three (3) bathrooms with One (1) bedroom being occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 113.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and skid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/20/2026. Emergency Disaster Plan was last posted on 06/27/2026. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2026. Continued LIC809C. Continued from LIC809 LPA attempted to review four (4) staff records, LPA observed S3, S4 are not fingerprint cleared/associated to facility. LPA also observed S4’s file was not at the facility during inspection. LPA reviewed four (4) residents records, and they were all current and complete. LPA requested updated copies of the following documents to be submitted to CCLD by 09/16/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Continue on LIC809C…. Continued from LIC809C... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:18AM, LPA observed facility did not have 7 days of nonperishable foods and 2 days of perishables. At 12:07PM, LPA observed S3, S4 are not fingerprint cleared/associated to facility. At 12:11PM, LPA observed S4 file was not at the facility for licensing to review. At 1:12 PM, LPA observed that R2 multivitamins and heartburn & gas tablets are missing doctor's order, and multivitamins are not listed on the Medication Administration Record (MAR). Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. ***a civil penalty of $1000.00 will be assessed today for S3, S4 fingerprint clearance*** Exit interview conducted with Paul Lam. Appeal Rights and a copy of this report were provided.the state’s words, verbatim · CDSS document, Sep 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Sep 11, 2026

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in having a 7-day supply of non-perishables and 2-day perishable foods which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Licensee agreed to purchase a variety of foods and submit photos to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Sep 18, 2026

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidence by: Based on record review and interview, licensee did not comply with the section above by not having a personnel file for S4 which poses a potential health and safter risk to the persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Licensee agreed to read regulation 87412,create personnel file fro S4 and send CCL a self-certifying email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 10, 2026

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department or..This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not having S3 and S4 fingerprint cleared which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Licensee has agreed to obtain fingerprint clearance for the two staff prior to the staff returning to work. Licensee will submit a written plan to CCLD by POC date. Civil penalty of $1000 is being assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 16, 2026

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above by not having a doctor's order for R2's flaxseed oil 1000mg, extra strength heartburn & gas (750 mg calcium carbonate/antiacid, 80 mg simethicone/anti-gas), calcium 600mg and fish oil 2400mg which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Licensee has agreed to obtain doctor's order for R2's daily vitamins and heart burn & gas tablets and submit the document to CCLD by POC date. Additionally, facility will update R2's MAR for future reviews.

Type of visit: Required - 1 Year

On 09/16/2025 at 2:30PM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Vergie Espiritu, Caregiver, LPA explained the purpose of visit. The Administrator arrived and LPA explained the purpose of visit. Facility has census of 4. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with Caregiver, Irma Martinez including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms, three (3) bathrooms with One (1) bedroom being occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 103.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and skid mats. 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 posted on 09/01/2025. First aid kit was observed to be complete. Fire drill was last conducted on 08/11/2025. Continued LIC809C. Continued from LIC809 LPA reviewed five (5) staff records and all five (5) resident records, and they all were current and complete. LPA requested updated copies of the following documents to be submitted to CCLD by 09/22/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies cited during today’s visit. Exit interview conducted and a copy of this report provided to Paul Lam.the state’s words, verbatim · CDSS document, Sep 16, 2025

Allegation investigated: Staff are not ensuring that resident is accorded privacy, dignity and respect while in care Facility did not communicate with resident for non-payments

On 08/21/2025 at 4:40PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. LPA met with Paul Lam, Administrator, and explained the reason for the visit. During the course of the investigation the LPA interviewed staff, resident, and reviewed and obtained records. Allegations: Staff are not ensuring that resident is accorded privacy, dignity and respect while in care During interviews with S1, S3 and R1 it was revealed that S3 did speak about non-payment of R1’s rent in front of staff and residents. S1, S3 and R1 stated during interviews that R1 brought it to S1’s attention of how uncomfortable R1 felt when S3 was discussing the non-payment in front of others, and that it should’ve been done privately. Continued on LIC9099C.. Substantiated Continued from LIC9099 R1 stated during interview, R1 had a lengthy conversation with S1 expressing frustration about how the situation was handled and that S1 did apologize for S3’s actions and agreed to have a conversation with S3. S1 and S3 admitted that the conversation should have been in a more private setting, not in front of other residents. Facility did not communicate with resident for non-payments During interviews with S1 and R1 it was revealed that S1 did not communicate with R1 regarding non-payments until R1’s rent wasn’t paid for two (2) months. S1 admitted during interview that S1 never brought up the issue to R1. R1 also stated during interview of having no knowledge of non-payment until the day S3 decided to talk about it in front of the other residents. 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 provide Continued from LIC9099A During record review it was revealed that R1’s physician changed two (2) out of the three (3) medications from daily dosage to a PRN. The Medication Administer Record (MAR) was also reviewed during the investigation and it revealed medications are being administered to R1 as per the physician’s order. Staff did not ensure that resident care needs were met while in care During interviews with S1, S2 and R1 it was revealed that staff does ensure the residents’ care needs are met. R1 stated during interview, staff does a great job assisting her daily needs, ready to live alone without care. S1 and S2 stated during interviews that all residents in care ADLs are handled by staff and that staff have been trained to handle residents’ needs. 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.the state’s words, verbatim · CDSS document, Aug 21, 2025 · control 15-AS-20250502142321

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Aug 28, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: This requirement is not met as evidence by: Based on interviews, licensee did not comply with section cited above by not communicating with resident for nonpayment which poses a potential personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: Administrator agreed to read 87468.1 and send a self certifying email to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Aug 28, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: This requirement is not met as evidence by: Based on interviews, licensee did not comply with section cited above by having a conversation about nonpayment in front of other residents which poses a personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: Administrator agreed to read 87468.2 and implement a plan on how facility will communicate regrading resident's nonpayment to CCLD by POC date.

Type of visit: Required - 1 Year

On 09/04/2024 at 1:20PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and David Doidge conducted an unannounced 1-Year Required inspection. LPAs met with Caregiver Irma Martinez, spoke with Administrator, Paul Lem via telephone, and explained the purpose of the visit. The Administrator arrived at 2:00PM. LPAs observed via CCL website that Administrator Certificate is currently in pending status. Facility has census of 4. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with Caregiver, Irma Martinez including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms, three (3) bathrooms with One (1) bedroom being occupied by staff .All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs 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 110.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and skid mats. 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 08/01/2024. Continued LIC809C. Continued from LIC809 LPAs reviewed Four (4) staff records and all four (4) resident records, residents records were current and complete. LPAs also reviewed medications During visit LPAs observed the following deficiencies: At 1:44PM LPAs observed there wasn't a minimum of 7-day supply of non-perishable and 2-day of perishable food for residents in care At 2:24PM LPAs observed during record review S2, S3 and S4 were all missing Health Screening documents At 3:17PM during medication review LPAs observed medication in kitchen refrigerator unlocked. LPAs requested updated copies of the following documents to be submitted to CCLD by 09/11/2024. · 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 (upon arrival) Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 4, 2024

Type of visit: Required - 1 Year

On 10/31/2023 at 9:15 AM, 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. 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 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 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 106.5 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 09/01/2023. Report continues on 809 C At 9:35 AM, LPA reviewed 6 of 6 residents records. At 10:00 AM, LPA reviewed 5 of 9 staff records and 5 of 5 have current first aid training and associated to the facility. At 10:15 AM, LPA reviewed a sample of 2 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