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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604677
Report Date: 08/16/2024
Date Signed: 08/16/2024 02:05:54 PM

Document Has Been Signed on 08/16/2024 02:05 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:FILLY LANE LLCFACILITY NUMBER:
374604677
ADMINISTRATOR/
DIRECTOR:
BERNARTE, WA LAIFACILITY TYPE:
735
ADDRESS:3661 FILLY LANETELEPHONE:
(619) 773-6087
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 4CENSUS: 4DATE:
08/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Administrator, Wa Lai BernarteTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. Administrator, Walai Bernarte welcomed LPA. LPA identified herself and discussed the purpose of the visit. The staff present had current criminal record clearances. The administrator certificate is valid until June 23, 2026.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, all of whom must be ambulatory. During today’s inspection, four (4) clients were in care, of which all were ambulatory. During today’s visit the clients were out in the community attending day program.

LPA, accompanied by Bernarte, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Clients’ bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies, as well as Personal Protective Equipment, were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant at 77 F. Hot water temperature at taps accessible to clients was compliant: Kitchen sink was 115 F.


There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required and stored in locked areas.

(Continue at LIC809C)
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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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: FILLY LANE LLC
FACILITY NUMBER: 374604677
VISIT DATE: 08/16/2024
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(Continue from LIC809)

Facility has a swimming pool in the backyard that is gated and locked. Per the licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records/files. The files that LPA reviewed contained the required documents. Confidential records were stored in a locked area. Liability insurance is current with expiration on July 30, 2025, and the surety bond is effective through June 22, 2026. First Aid certificates were current for all staff through 2025 - 2026. Facility staff conducted an emergency drill on June 22, 2024. Staff training was current as of August 2024 for all staff as required per Title 22 regulations.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Administrator, Walai Bernarte to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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