370804484-7-21-2025-08-AS-CLOZ-DJT3LN-20250721182102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370804484
Report Date: 07/21/2025
Date Signed: 07/21/2025 06:23:39 PM

Document Has Been Signed on 07/21/2025 06:23 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'S GUEST HOME		FACILITY NUMBER:	370804484
ADMINISTRATOR/ DIRECTOR:	ANGELITA SANCHEZ		FACILITY TYPE:	740
ADDRESS:	1576 CASTEEL COURT		TELEPHONE:	(619) 267-5909
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY: 5		CENSUS: 2	DATE:	07/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Vanessa Sanchez, Administrator		TIME VISIT/ INSPECTION COMPLETED:	06:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Teofila Mayo. LPA discussed the purpose of the visit with Administrator Vanessa Sanchez. Licensee Angelita Sanchez later arrived and joined the visit. According to the facility’s license, there may be a maximum of five (5) residents, four (4) of whom may be non-ambulatory in rooms 1, 2, and 4 in at any given time at the facility site. The facility is approved for a wheelchair in room #4 and 1 hospice is approved. During today’s inspection, the facility’s current census is two (2) residents living at the facility. There were 2 residents present at the facility site during the inspection. LPA, accompanied by caregiver Erminda Aquino, toured the interior and exterior of the facility, and inspected each room. The facility was clean and in good repair. There was an insect found during the inspection. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 73 degrees F. Hot water temperature at taps accessible to residents read as follows: kitchen sink initially measured hot water at 135 degrees F but later measured 111 degrees F; sink in restroom #1 delivered hot water at 120 degrees F; sink in restroom #2 initially delivered hot water at 136 degrees F, but later measured at 113.5 degrees F; and sink in restroom #3 initially measured hot water at 137.7 degrees F, but later measured at 111.6 degrees F. The hot water temperatures were lowered during the inspection and were cleared. [CONTINUED ON LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

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 07/21/2025 06:23 PM - It Cannot Be Edited

Created By: Carmen Lopez On 07/21/2025 at 03:32 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'S GUEST HOME	FACILITY NUMBER: 370804484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87202(a)(1)

Fire Clearance

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (1) Nonambulatory persons. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 2 residents were not cleared to reside in an ambulatory room which posed an immediate safety risk to persons in care.
	POC Due Date: 07/22/2025
	Plan of Correction
1 2 3 4	The resident was moved from bedroom #5 to bedroom #4 during the visit. This violation is deemed cleared during this annual inspection.

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.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/21/2025 06:23 PM - It Cannot Be Edited

Created By: Carmen Lopez On 07/21/2025 at 03:32 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'S GUEST HOME	FACILITY NUMBER: 370804484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87208(a)(6)

Plan of Operation

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (6) Plan for training staff, as required by Health and Safety Code sections 1569.625, 1569.626, and 1569.69 and as specified in Section 87411, Personnel Requirements–General and Section 87705, Care of Persons with Dementia. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff training records were not on file which posed a potential personal rights risk to persons in care.
	POC Due Date: 09/01/2025
	Plan of Correction
1 2 3 4	Facility will ensure they obtain copies of staff training and keep in a confidential area of the facility and email LPA a photo of their printed copy by POC due date, 09/01/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/21/2025 06:23 PM - It Cannot Be Edited

Created By: Carmen Lopez On 07/21/2025 at 03:32 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'S GUEST HOME	FACILITY NUMBER: 370804484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87412(a)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff records were not complete which posed a potential personal rights risk to persons in care.
	POC Due Date: 09/01/2025
	Plan of Correction
1 2 3 4	Facility agreed to obtain completed staff records and email LPA the completed record by POC due date 09/01/2025.

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.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/21/2025 06:23 PM - It Cannot Be Edited

Created By: Carmen Lopez On 07/21/2025 at 03:32 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'S GUEST HOME	FACILITY NUMBER: 370804484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87406(a)(1)(B)

Administrator Certification Requirements

(a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (1) Applicants who possess a valid Nursing Home Administrator license, issued by the California Department of Public Health, shall be exempt from completing an approved Initial Certification Training Program and taking a written exam, provided the individual completes twelve (12) hours of classroom instruction in the following Core of Knowledge areas: (B) Four (4) hours of instruction in medication management, including the use, misuse, and interaction of drugs commonly used by the elderly, including antipsychotics, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff did not obtain their medication training after a citation on 04/15/2024 was issued which posed a potential health, risk to persons in care.
	POC Due Date: 08/01/2025
	Plan of Correction
1 2 3 4	Facility agreed to have staff schedule medication training which has been scheduled for 7/25/25. This is deemed cleared during this inspection. Facility will be submitting their medication training certificate to LPA once training is complete.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/21/2025 06:23 PM - It Cannot Be Edited

Created By: Carmen Lopez On 07/21/2025 at 03:32 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'S GUEST HOME	FACILITY NUMBER: 370804484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87555(b)(27)

General Food Service Requirements

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 out of 1 cockroaches were found in the kitchen area which posed a potential personal rights risk to persons in care.
	POC Due Date: 09/26/2025
	Plan of Correction
1 2 3 4	Facility agreed to purchase a cockroach killer and spread throughout the facility and have it free from cockroaches by POC due date 09/26/2025.

Type B

Section Cited

HSC

1569.695(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 quarterly fire drills were not maintained which posed a potential safety risk to persons in care.
	POC Due Date: 08/01/2025
	Plan of Correction
1 2 3 4	Facility will conduct a quarterly fire drill and submit a copy to LPA by POC due date 08/01/2025. They will maintain drills every 2 months thereafter and submit by 12/31/2025.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:

	Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. JOSEPH'S GUEST HOME	FACILITY NUMBER: 370804484
	VISIT DATE: 07/21/2025

NARRATIVE

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[CONTINUED FROM LIC 809]

There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked areas which LPA inspected. The facility-maintained medication logs which LPA reviewed.

No pools or bodies of water on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kit was complete and readily accessible.

LPA interviewed staff and residents, and reviewed staff and resident records. LPA interviews did not raise any licensing concerns. The resident files which LPA reviewed contained required documents. Staff files were not complete but were stored in a locked area. Required licensing postings were observed in a visible area of the facility.

On July 7, 2022, the facility was cited on section, 87211(a)(1)(D) Reporting Requirements, Any incident which threatens the welfare, safety or health of any resident. The facility had ongoing construction which threatened the welfare of the residents, that was not reported to the Department. This citation is being cleared during this annual inspection. Title Section, 87305 (a) Alterations to Existing Buildings or new facility is being cited and is cleared during todays inspection. It may be reviewed on the LIC809-D page of this report.

On April 15, 2024, the facility was cited on sections 87458(a) Medical Assessment, which is being cleared during today’s inspection. All medical assessments for residents in care are current and on file. The facility was also cited for 87465 (a)(5)(A) Incidental Medical and Dental Care, Medications usually prescribed for self-administration which have been authorized by the person's physician. This section is being cleared during this inspection. Although Incidental Medical and Dental Care are cleared, the facility is pending staff medication training and is being cited during today’s inspection which may be reviewed on the LIC809-D page of this report.

[CONTINUED FROM LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. JOSEPH'S GUEST HOME	FACILITY NUMBER: 370804484
	VISIT DATE: 07/21/2025

NARRATIVE

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[CONTINUED FROM LIC 809-C]

There are additional deficiencies observed and being cited during today's annual inspection which can be reviewed on the LIC809-D page(s) of this report.

An exit interview was conducted with Administrator Vanessa Sanchez and Licensee Angelita Sanchez to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.

LPA requested Administrator Sanchez to submit a current Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E, to the licensing office within 10 business days. A current Designation of Administrative Responsibility LIC 308 was provided to LPA during the visit. Forms are available at www.ccld.ca.gov.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025

LIC809 (FAS) - (06/04)

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