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ICF/DD-H (Habilitative)License activeMedi-Cal certified

MICHALOWSKI HOME

ICF/DD-H (Habilitative) · 5 licensed beds · Carlsbad, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

MICHALOWSKI HOME6205 ALVERTON DRCarlsbad, CA 92009 · San Diego County

Phone: (760) 721-1706

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
5
Licensee
T.E.R.I., INC. · Nonprofit Corp
Administrator
WEAVER, KEILEISHA
CDPH facility ID
630012839
License number
550001562
First licensed
May 5, 2011
Current license
May 5, 2026 to May 4, 2027
CDPH district office
San Diego

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G665
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
July 29, 2011
Last certification survey
June 18, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (non-profit)
Certified beds (CMS)
5
Staffing reported to CMS
RN 0.33 · LVN/LPN 0 · direct care 7 · all employees 7.33

State citations and penalties (CDPH)

1 penalty, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BAbuse/Facility Not Self Reported

    Citation - B · Violations: 483.420(d)(2) · Violation Feb 25, 2025 · Penalty #100022203 · Survey MDHK11

    Status: Closed

Federal inspections (CMS-2567)

21 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event 341ED6-H1 · no deficiencies cited

    Official 2567 ↗
  2. · Recertification

    Event MDHK21 · 1 deficiency

    Official 2567 ↗
  3. · Complaint

    Event TI8811 · no deficiencies cited

    Official 2567 ↗
  4. · Recertification

    Event MDHK11 · 1 deficiency

    Official 2567 ↗
  5. · Recertification

    Event R8T221 · 1 deficiency

    Official 2567 ↗
  6. · Recertification

    Event R8T211 · 2 deficiencies

    Official 2567 ↗
  7. · Complaint

    Event CG6O11 · no deficiencies cited

    Official 2567 ↗
  8. · Recertification

    Event X6FG21 · 1 deficiency

    Official 2567 ↗
  9. · Recertification

    Event X6FG11 · 3 deficiencies

    Official 2567 ↗
  10. · Complaint

    Event PH0E11 · no deficiencies cited

    Official 2567 ↗
  11. · Complaint

    Event N12W11 · no deficiencies cited

    Official 2567 ↗
  12. · Complaint

    Event I8CI11 · no deficiencies cited

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

23 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  2. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  3. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  4. ReportState Class B citation ($1,600)(state record)

    See this citation →
  5. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  6. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  7. ReportFederal survey (recertification): 2 deficiencies(state record)

    See this survey →
  8. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  9. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  10. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.