Cristobal Way RCFE

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit to cite a deficiency which was directly related to a complaint investigation visit. LPA identified herself to and discussed the purpose of the visit with Milagros "Mila" Postert , Administrator During review of records, LPA observed, and administrator interview confirmed: Licensee did not possess a Health Screening, no Personnel Record or a current first aid for Staff 1 (S1). Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the Administrator. An exit interview was conducted with Milagros "Mila" Postert , Administrator, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Sep 17, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(1-6) · Plan of correction due date: Sep 25, 2026

(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:(1)Employee's full name.(2) Social Security number. (3) Date of employment.(4) Written verification that the employee is at least 18 years of age, including, but not necessarily limited to, a copy of his/her birth certificate or driver's license. (5) Home address and telephone number.(6)Educational background. This requirement was not met, as evidenced by: Based on records review and manager interview, Licensee did not ensure that staff 1 (S1) personnel record contained documentation of educational background and prior training and/or experience. This posed a potential health and safety risk to 1 of 4 residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee agreed to coordinate with all staff to have each person complete all documents needed for their file. Licensee agreed to add these documents to their employee files, and to E-mail copies to LPA, by the POC due date. Licensee agreed to independently audit all staff files to ensure that they are not missing this data.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Sep 25, 2026

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met, as evidenced by: Based on records review and manager interview, Licensee did not ensure that staff 1 (S1) personnel record contained documentation of a current first aid card. This posed a potential health and safety risk to 1 of 4 residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee agreed to coordinate with all staff to have each person retroactively complete and complete a LIC501 Licensee agreed to add these documents to their employee files, and to E-mail copies to LPA, by the POC due date. Licensee agreed to independently audit all staff files to ensure that they are not missing this data

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Sep 25, 2026

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement was not met, as evidenced by: Based on records review and manager interview, Licensee did not ensure that Staff 1 (S1) personnel record contained documentation of educational background and prior training and/or experience. This posed a potential health and safety risk to 4 of 4 (R1-R4) residents in care..the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee agreed to coordinate with all staff to have each person complete all documents needed for their file. Licensee agreed to add these documents to their employee files, and to E-mail copies to LPA, by the POC due date of 09/25/2026. Licensee agreed to independently audit all staff files to ensure that they are not missing this data.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Brett Porcioncula, Staff. According to the facility’s license, the facility has a maximum capacity of four residents with all four being non ambulatory. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents 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 no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Porcioncula, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kits were complete and readily accessible. Deficiencies were cited on today's visit. An exit interview was conducted with Porcioncula, Staff, 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, May 26, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit. LPA met with Filemon Radurat, Caregiver, and we discussed the purpose of the visit. Milagros "Mila" Postert , Administrator arrived during the visit. On 11/25/2025, the Regional Office received a Title 17 Deficiencies/Corrective Action Plan regarding the facility. San Diego Regional Center (SDRC) staff noted on 11/24/2025 that clients medications were observed and locked, however, the cold refrigerator medications were not locked. The key was in the mini refrigerator, but staff were unable to lock it. It was also observed by the SDRC Liaison the Fire Drill Log showed that a fire drill had occurred on 11/24/25. Among the staff and residents, the log also listed that administrator was present for the fire drill. Interviews revealed the Liaison asked and administrator indicated that they weren’t there for the fire drill. Later, this liaison interviewed one of the residents and they weren’t able to discuss what to do in a fire. According to this interview, the client indicated that they didn’t recall a fire drill earlier in the day. Interviews revealed the providers use verbal commands to call the fire drill. Interviews with staff also revealed, that the home was currently lacking a working fire alarm. Interviews with staff also revealed, that the home was currently lacking carbon monoxide dectectors. During today's visit, LPA discussed the issues identified on the Title 17 Deficiencies/Corrective Action Plan. Plan of Corrections for the Title 17 Deficiencies were reviewed. As such, the applicable regulations will be cited for deficiencies observed by an outside agency. During today's visit, the Title 17 deficiencies noted above, were observed to be corrected on this date except for one which requires training for staff, however, these applicable deficiencies are cited in accordance with the California Code of Regulations, Title 22, Division 6, Chapters 1 and 6, and are noted on the attached LIC809-D. The Licensee was provided a copy of their appeal rights (LIC9058 03/22), and their authorized representative's signature on this form, acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided at the conclusion of the visitthe state’s words, verbatim · CDSS document, Dec 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Dec 12, 2025

87203 Fire Safety: “All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.” This requirement was not met, as evidenced by: Based on SDRC observation, Licensee did not maintain the facility in continuous conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire. This posed an immediate safety risk to 4 of 4 residents (R1 through R4) in care.the state’s words, verbatim · CDSS document, Dec 9, 2025

Plan of correction: During today’s visit, Licensee remedied the seven (7) non-working smoke alarms. POC is completed and cleared.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.311 · Plan of correction due date: Dec 12, 2025

Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in not having any carbon monoxide detectors. This posed an immediate safety risk to 4 of 4 residents (R1 through R4) in care.the state’s words, verbatim · CDSS document, Dec 9, 2025

Plan of correction: Licensee purchased two (2) new carbon monoxide detectors. POC is completed and cleared

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Dec 12, 2025

H&S 1569.695 Emergency Plans (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 was not met as evidenced by: Based on records review, the facility did not have quarterly fire drills on file for the facility which posed a potential safety risk to 4 [R1, R2, R3 and R4] of 4 persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2025

Plan of correction: The fire drill form for the facility was filled out and the fire drill was performed on 12/07/2025 LPA obtained a copy of the fire drill. This POC is deemed completed and cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(2) · Plan of correction due date: Dec 26, 2025

Incidental Medical and Dental Care Services. Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication, this requirement was not met as evidenced by: Based on review, the facility did not have refrigerated medications locked for 4 of 4 residents [R1, R2, R3& R4]. This posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2025

Plan of correction: Licensee has agreed to speak with all staff and enforce medications to be locked and at all times. Licensee will submit a plan to ensure medications will be inaccessible to residents. Licensee will also provide training to all staff by an outside source. POC due date of 12/26/2025. POC documentation (training documents and sign in sheet) will be sent to CCL by POC due date by email.

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 03/10/2025. The facility was approved to care for four (4) Elderly Residents; LPA was greeted and allowed entry into the facility by and met with Dominque John, Applicant. Structure- The facility is a single story structure with 4 bedrooms and 3 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents- Rooms #1, #2, will be shared room for Non-Ambulatory clients Bedrooms Staff- 2 other rooms/1 for staff room and the other is an office Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 114.4 degrees F. Medications- Centrally stored and locked in a cabinet in the lounge area. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- Located cabinet. Activities- Adequate supplies to include exercising, games and puzzles for resident's use. Fire clearance- Approved on 05/30/2025. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Dominque John, Applicant signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 4 Census (if any clients in care): 0 COMP II Participants: Dominique John Mase CEO/Administrator Interview Method: Telephone interview On June 6, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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, Jun 6, 2025