House of Peace

Type of visit: Required - 1 Year

At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. LPA met with the Administrator and explained the reason for the visit. A tour of the physical plant was initiated at 11:35am and the following was observed: The Fire Clearance is approved for a maximum capacity of six (6) residents, of which five (5) can be Non-Ambulatory and one (1) Bedridden residents. Hospice waiver for six (6) residents is also approved. Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher was last serviced on 07/10/2025. Bedrooms: The facility has five (5) bedrooms designated for residents’ use. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm. The facility has awake staff Bathrooms: Facility has two (2) bathrooms. Bathrooms have soap, paper towels and hand washing signs were observed. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 105.4°F Common Areas: Medications and resident/staff files are kept in a metal, file cabinet, located by the kitchen and kept locked and inaccessible to residents in care. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Continue on LIC809-C The facility maintains a comfortable temperature of 73°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Smoke detectors carbon monoxide is located throughout the facility and at 12:30pm they were tested and observed to be operational. Laundry Room: The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Areas: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for the residents. The outdoor area is free of visible immediate hazards. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Between 12:30am to 1:30am, LPA reviewed records of LPA reviewed records of six (6) residents and three (3) staff. Residents and staff records appeared to be complete and updated. Residents’ files contain signed admission agreements, medical assessment, and all other required documentation. Annual fee is paid in full. LPA observed Administrator certificated renewed on 05/30/25 with an expiration date of 05/29/27 No citations issued during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Required - 1 Year

At 12:30pm Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff and the Administrator was contacted via phone. The Administrator arrived shortly after and LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following: The facility has an approved fire clearance for six (6) bedridden and six (6) hospice residents. Kitchen: At approximately, 1:05pm LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum one (1) week and perishable for two (2) days at the facility. All knives and sharps observed to be locked in the kitchen drawer. LPA observed a fully charged fire extinguisher in the kitchen. Medications: At approximately, 1:10pm LPA observed medications are centrally stored and locked in a medication cart/cabinet. A fully stocked First Aid Kit was kept by the medication cart/cabinet. Bedrooms: LPA observed total of five (5) bedrooms designated for clients use. Bedrooms #1, #2 #3 and #4 are private and bedroom #5 is shared. All bedrooms are properly furnished, clean and have appropriate bedding and linens. LPA also observed one (1) hospital bed (in room # 2) with full rail and two (2) hospital beds (in rooms #3 and #4) with ½ bed rails, without a written physician orders in place/on file. Bathrooms: LPA observed two (2) bathrooms, and both appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. Hot water temperature measured at 119.1°F. Continue on LIC 809C Common Areas: The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The garage was locked and contained an extra refrigerator and freezer, paper supplies, incontinence supplies, and PPE. The garage was also used as a laundry room and LPA observed all the laundry detergent and other cleaning supplies to be locked and inaccessible to residents in care. LPA measured the room temperature to be 72°F. A fireplace in the living room was inaccessible and covered appropriately. Residents and staff were doing activities in the living room during the visit. Games, art materials, and television were provided. Smoke detectors/carbon monoxide. Smoke detectors and carbon monoxide were located throughout the facility, and at 1:30pm they were tested and observed to be operational. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture with a covered patio for residents’ use. Between 1:50pm to 3:00pm, LPA reviewed records of four (4) clients and one (1) staff. Administrative: LPA attempted to collect Certificate of Liability Insurance but was informed by the Administrator that no insurance is available at this time. Per the California Code of Regulations, Title 22, deficiencies are cited and noted on LIC-809D. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 23, 2024