St Joseph Caregiving

Type of visit: Post Licensing

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.the state’s words, verbatim · CDSS document, Aug 13, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Health Checks visit. LPA was greeted and allowed entry into the facility by Volunteer, Sandy Kassab. LPA met with Administrator, Maryana Isho and discussed the purpose of the visit. During today's visit, LPA briefly toured the facility and collected records. There were no health and/or safety concerns observed during the visit. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Maryana Isho whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 11, 2026

Type of visit: Case Management - Deficiencies

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.the state’s words, verbatim · CDSS document, Jul 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 21, 2026

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: 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.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: 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

From the deficiency page — Deficiency type: Type A · Section cited: CCR87506(a) · Plan of correction due date: Jul 30, 2026

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 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.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: 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

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87553(e)(3) · Plan of correction due date: Jul 29, 2026

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) 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.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: 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

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Jul 29, 2026

87412 Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. 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.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: 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

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angelica Boyles conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s representative, Maryana Isho. The facility fire clearance was granted on 7/14/25 and reflected that the facility was approved for six (6) residents in total, of which five (5) may be non-ambulatory and one (1) may be bedridden. The facility's fire clearance did not include delayed-egress door or secured perimeter endorsements, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was comfortable and compliant and hot water temperature at taps accessible to residents were also compliant. (Continued on LIC809-C) (Continued from LIC809) The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. The applicant was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative, Maryana Isho, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: ISHO, MARYANA Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 29, 2025