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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604963
Report Date: 08/13/2026
Date Signed: 08/13/2026 05:44:10 PM

Document Has Been Signed on 08/13/2026 05:44 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: 2DATE:
08/13/2026
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Diana Cuevas, DSP/CaregiverTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) David Roman, Licensing Program Managers (LPM) Simon Jacob and Lizzette Tellez, conducted an unannounced Post Licensing inspection visit. LPA identified himself, introduced himself, and discussed the purpose of the visit with Caregiver, Diana Cuevas. According to the facility’s license, the facility has a maximum capacity of 6 clients non-ambulatory of which 1 may be bedridden in room 3. Hospice waiver granted for 2.

LPA D. Roman along with facility staff toured the interior and exterior of the facility and inspected bedrooms and bathrooms. The facility was sanitary, and in good repair. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 120 degrees F. No pools or bodies of water on the premises. Per DSP staff, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting were working. No night lights in the hallways and facility telephone was not working. Fire extinguishers were present. First aid kits were complete and readily accessible. Pathways were free of obstruction and slip hazards.

Resident records were incomplete and missing required documentation. Staff records were not made available. Deficiencies were cited today for toxic chemicals, lack of records, lack of staff, lack of training, lack of first aid training, and multiple technical violations were issued.

An exit interview was conducted with DSP/Caregiver, Diana Cuevas, to whom a copy of this report and the Licensee/Appeal Rights, LIC 809-Ds and LIC 9102s were provided during the visit.
Lizzette Tellez
David Roman
DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 16
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)
Page: 2 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:22 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
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2
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4
On this day the Licensee was served with a TSO and the facility is closed.
Type A
Section Cited
HSC
1569.618(c)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 3 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:23 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87412(a)(13)
Personnel Records
(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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
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2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
Type A
Section Cited
CCR
87355(e)
Criminal Record Clearance
(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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
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2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 4 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:24 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.625(b)(1)
Other Provisions
(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
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2
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4
On this day the Licensee was served with a TSO and the facility is closed.

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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 5 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:25 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87411(c)(1)
Personnel Requirements - General
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

On this day the Licensee was served with a TSO and the facility is closed.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
Type A
Section Cited
CCR
87506(a)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 6 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:25 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87633(a)(4)
Hospice Care for Terminally Ill Residents
(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident's hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident's or prospective resident's Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.

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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 7 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:26 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(f)
Maintenance and Operation
(f) All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87307(a)(2)(B)
Personal Accommodations and Services
(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 8 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:28 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(e)
Personal Accommodations and Services
(e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87309(a)(2)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (2) Any items in subsection (a)(1) that are transferred from their original container to another container shall have a legible label that indicates:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4

On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 9 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:28 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87311
Telephones
All facilities shall have telephone service on the premises. Facilities with a capacity of sixteen (16) or more persons shall be listed in the telephone directory under the name of the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4

On this day the facility was served with a TSO and the facility is closed.
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4

On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 10 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:29 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(f)
Personnel Records
(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87411(d)
Personnel Requirements - General
(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 11 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:29 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(c)
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87411(c)(6)
Personnel Requirements - General
(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 12 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:30 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.626(a)
Other Provisions
(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.


POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87555(b)(8)
General Food Service Requirements
(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4

Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 13 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:30 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87555(b)(26)
General Food Service Requirements
(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:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
The licensee was served with a TSO, the facility is closed.
Type B
Section Cited
CCR
87457(c)
Pre-Admission Appraisal
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
The licensee was served with a TSO, the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 14 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:31 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87458(a)
Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
Type B
Section Cited
CCR
87633(h)(5)
Hospice Care for Terminally Ill Residents
(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the Licensee was served with a TSO and the facility is closed.
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 15 of 16
Document Has Been Signed on 08/13/2026 05:44 PM - It Cannot Be Edited


Created By: David Roman On 08/13/2026 at 03:31 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: 08/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87705(b)
Care of Persons with Dementia
(b) Licensees shall be responsible for the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 2 persons in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
1
2
3
4
On this day the facility was served with a TSO and the facility is closed.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
David Roman
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2026


LIC809 (FAS) - (06/04)
Page: 16 of 16