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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604963
Report Date: 07/29/2026
Date Signed: 07/29/2026 04:40:45 PM

Document Has Been Signed on 07/29/2026 04:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ST JOSEPH CAREGIVINGFACILITY NUMBER:
374604963
ADMINISTRATOR/
DIRECTOR:		ISHO, MARYANAFACILITY TYPE:
740
ADDRESS:719 TAFT AVENUETELEPHONE:
(619) 815-2679
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 6CENSUS: 3DATE:
07/29/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Administrator Maryana IshoTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Case Management visit to the facility while the LPA was opening a complaint investigation to cite deficiencies.  LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Maryana Isho. During Today's visit, there were three (3) residents in care.

As LPA was conducting file review at the facility, LPA noted that per the administrator there are four (4) employees currently working at the facility including administrator. Per the administrator, employees had no background clearance records to provide to the LPA during their visit. Only the administrator was associated to the facility in Guardian. S1 has been working at the facility since January 2026, S2 since May 2026, and S3 since February 2026. S1 is cleared in guardian but not associated with the facility. During the Audit, the LPA also noted that the staffing and resident files were incomplete.

Three type A Deficiencies and one type B deficiency are being cited per California Code of Regulations, Title 22, Division 6 (please see attached LIC 809-D Pages), Two Civil Penalties are being assessed for the total amount of $1500.00 due to lack of S1, S2, and S3 fingerprinting and association. Details are noted on the attached LIC 421BG form.

An exit interview was conducted with Administrator Maryana Isho to whom a copy of this report, the LIC 421BG's, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
Lizzette Tellez
Ramin Hashemi
DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/29/2026 04:40 PM - It Cannot Be Edited


Created By: Ramin Hashemi On 07/29/2026 at 11:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST JOSEPH CAREGIVING
FACILITY NUMBER: 374604963

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2026
Section Cited
CCR
87355(e)(2)

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87355 Criminal Record Clearance
(e) All individuals subject to a criminal record review... 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 evidenced by:
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Immediately, Licensee has restricted non-cleared staff from returning to the facility. Licensee will provide documentation of cleared and associated staff to CCLD Offices by 08/21/2026
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Based on record review, the licensee did not comply with the section cited above in 2 out of 4 staff did not have criminal record clearance, which poses an immediate safety risk to 3 out of 3 persons in care.
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Type A
07/30/2026
Section Cited
CCR87506(a)

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87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff
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Within 24 hours, licensee provide deadline reagarding procuring resident documents. Licensee will procure all required resident records for current residents (3 of 3) and show roof of documentation will be sent by 08/21/2026
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Based on record review, the licensee did not comply with the section cited above in that resident records were incomplete, which poses an immediate safety risk to 3 out of 3 persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Ramin Hashemi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/29/2026 04:40 PM - It Cannot Be Edited


Created By: Ramin Hashemi On 07/29/2026 at 02:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST JOSEPH CAREGIVING
FACILITY NUMBER: 374604963

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2026
Section Cited
CCR
87553(e)(3)

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87553 Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance as specified in Section 87355(c)
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Licensee will contact the CPMB to associate Staff 1 within 24 hours. Licensee agreed to restrict other unassociated staff members to the facility until they were associated. Proof of Association is to be submitted to CCLD Offices by 08/21/2026
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Based on record review, the licensee did not comply with the section cited above in 1 out of 4 staff had clearance but were not associated,which poses an immediate safety risk to 3 out of 3 persons in care.
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Type B
07/29/2026
Section Cited
CCR87412(a)

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87412 Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
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Licensee will procure all required personnel records for current staff (4 of 4) and proof of documentation will be sent to CCLD Offcies by 08/21/2026
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Based on record review, the licensee did not comply with the section cited above in 4 out of 4 personnel records were incomplete which poses an potential safety risk to 3 out of 3 persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lizzette Tellez
NAME OF LICENSING PROGRAM MANAGER:
Ramin Hashemi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2026


LIC809 (FAS) - (06/04)
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