374603309-12-2-2025-08-AS-MGCO-DNZ572-20251202184134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603309
Report Date: 12/02/2025
Date Signed: 12/02/2025 06:53:44 PM

Document Has Been Signed on 12/02/2025 06:53 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:	BONITA RESIDENTIAL CARE		FACILITY NUMBER:	374603309
ADMINISTRATOR/ DIRECTOR:	WA LAI BERNARTE		FACILITY TYPE:	735
ADDRESS:	4807 DEL PRADO STREET		TELEPHONE:	(619) 942-3642
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 6		CENSUS: 6	DATE:	12/02/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Licensee, Wa Lai Bernarte		TIME VISIT/ INSPECTION COMPLETED:	04:20 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) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Caregiver Theresa Sy. Administrator/Licensee Wa Lai Bernarte arrived later, and LPA disclosed the purpose of the visit. According to the facility’s license, it is approved to serve six (6) developmentally disabled ambulatory clients. During this inspection, six (6) clients were in care, four (4) of whom were out in the community. All clients were ambulatory. The facility does not have a secured perimeter or delayed egress doors. LPA Garcia-Centeno toured the interior and exterior of the facility with Caregiver Sy. Client rooms were inspected and found to contain the required furnishings. The facility was clean and in good repair. Pathways were free of obstructions and slip hazards. Doors, toilets, and showers were operational. Extra linens and hygiene supplies were available. The facility had sufficient space and equipment for dining, laundry, visitation, meetings, and client activities. Internal temperature, refrigerator, and freezer temperatures were within the regulatory range. The shower facility was equipped with a grab bar; however, it did not meet Title 22 requirements for one of the clients in care. The bar was observed to be unstable and not sufficient to ensure client safety. (Continue at LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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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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: BONITA RESIDENTIAL CARE	FACILITY NUMBER: 374603309
	VISIT DATE: 12/02/2025

NARRATIVE

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(Continue from LIC809)

The hot water temperature from the kitchen faucet accessible to clients was measured and found to be within the regulatory range. At least two (2) days of perishable food and seven (7) days of non-perishable food were present and safely stored. Cooking and dining equipment and utensils were available.

No sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters were accessible to clients. Medications were properly labeled and secured in locked storage. Confidential client and staff records were appropriately stored. No pools or bodies of water were observed on the premises. Per the Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and the facility telephone were operational. The fire extinguisher was serviced within the last 12 months (January 2, 2025). Staff conducted a fire drill on November 6, 2025. The first aid kit was complete and readily accessible. Required licensing postings were visible in the facility.

LPA interviewed staff and reviewed staff and client records. No licensing concerns were identified. Client files reviewed contained all required documentation. Staff records included proof of current first aid training, effective July 2024 - July 2026. The licensee provided proof of current business liability insurance (March 4, 2026) and a surety bond, as required by Title 22 regulations.

A deficiency was cited per Title 22 regulations and documented on the attached LIC 809D. A plan of correction (POC) was developed with Licensee, Wa Lai Bernarte.

The Licensee was provided a copy of her appeal rights (LIC 9058 03/22). An exit interview was conducted with Administrator Bernarte, and a copy of this report and LIC809D Deficiency Report were provided at the conclusion of the visit

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/02/2025 06:53 PM - It Cannot Be Edited

Created By: Marisela Garcia-Centeno On 12/02/2025 at 03:48 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: BONITA RESIDENTIAL CARE	FACILITY NUMBER: 374603309
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(3)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, staff interviews and records review, the licensee did not comply with the section cited above, the shower area available for client (C1) use did not meet client's needs. This posed a safety risik for clients in care.
	POC Due Date: 01/02/2026
	Plan of Correction
1 2 3 4	The licensee agreed to equip the shower area with grab bar to meet Title 22 regulations. Licensee will submit proof of POC by due date of 1/2/2026.

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.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Marisela Garcia-Centeno
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC809 (FAS) - (06/04)

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