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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200993
Report Date: 10/08/2025
Date Signed: 10/08/2025 04:02:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
08/27/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250827171228
FACILITY NAME:DESIRED PEACE HOME CARE 2FACILITY NUMBER:
079200993
ADMINISTRATOR:LAM, PAUL K.FACILITY TYPE:
740
ADDRESS:2024 SAGE SPARROW STREETTELEPHONE:
(510) 759-8889
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:6CENSUS: 5DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Paul Lam. AdministratorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Facility is in financial distress.
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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-20250827171228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: DESIRED PEACE HOME CARE 2
FACILITY NUMBER: 079200993
VISIT DATE: 10/08/2025
NARRATIVE
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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.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2