374604677-8-7-2025-08-AS-MGCO-DKC62M-20250807202547

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604677
Report Date: 08/07/2025
Date Signed: 08/07/2025 08:30:20 PM

Document Has Been Signed on 08/07/2025 08:30 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 LLC		FACILITY NUMBER:	374604677
ADMINISTRATOR/ DIRECTOR:	BERNARTE, WA LAI		FACILITY TYPE:	735
ADDRESS:	3661 FILLY LANE		TELEPHONE:	(619) 773-6087
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 4		CENSUS: 4	DATE:	08/07/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:50 PM
MET WITH:	Administrator, Wa Lai Bernarte		TIME VISIT/ INSPECTION COMPLETED:	04:30 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) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. Upon arrival, staff member Anamel Orante Lauguico greeted LPA. LPA identified herself and explained the purpose of the visit. All staff present had current criminal record clearances. Administrator Wa Lai Bernarte arrived during the inspection. The administrator certificate is valid through June 23, 2026. According to the facility’s license, the maximum capacity is four (4) ambulatory clients. At the time of the inspection, four (4) clients were in care, all of whom were ambulatory. One client was out in the community during the visit. LPA, accompanied by Lauguico, 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 obstructions and slip hazards. Clients' bedrooms contained the required furnishings. All doors, windows, screens, toilets, and showers were operational. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were available. The facility had adequate space and equipment for dining, laundry, visitation, meetings, and client activities. The ambient indoor temperature was 76°F. Hot water temperature at the kitchen sink was measured at 117°F, within the regulatory range. Food supplies met licensing requirements, with at least two days of perishable and seven days of non-perishable food, all properly stored. Cooking and dining equipment and utensils were available. No sharp objects, toxic chemicals, or open-faced heaters were accessible to clients. Medications were properly labeled and stored in locked areas. (continue at LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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: FILLY LANE LLC	FACILITY NUMBER: 374604677
	VISIT DATE: 08/07/2025

NARRATIVE

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(continue from LIC809)

The facility has a swimming pool in the backyard that is currently under construction. During the inspection, tools, chemicals, wood, cement blocks, and other construction materials were observed in the area. These items pose a potential safety hazard to clients in care. Although clients are supervised at all times to prevent access to the backyard, this condition represents a safety concern. As a result, a deficiency was cited in accordance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and is documented on LIC809D. A Plan of Correction (POC) was developed in collaboration with Administrator Bernarte.

The licensee confirmed that no firearms or ammunition are kept on the premises. Carbon monoxide detectors, emergency lighting, and the facility telephone were all operational. The fire extinguisher was serviced within the past 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible locations.

LPA conducted staff and client interviews and reviewed multiple staff and client records. All reviewed files contained the required documentation. Confidential records were stored in a locked area. Liability insurance is current through July 30, 2026, and the surety bond is valid through June 22, 2026. First Aid certificates for all staff were current through 2025–2026. The facility conducted its most recent emergency drill on July 5, 2025. Staff training was up to date as of August 2025, in compliance with Title 22 regulations.

An exit interview was conducted with Administrator Wa Lai Bernarte. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/07/2025 08:30 PM - It Cannot Be Edited

Created By: Marisela Garcia-Centeno On 08/07/2025 at 04:45 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: FILLY LANE LLC	FACILITY NUMBER: 374604677
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in ensuring to maintain the backyard free from hazzards during contruction. This posed a potential safety risk to 4 of 4 clients in care.
	POC Due Date: 08/15/2025
	Plan of Correction
1 2 3 4	Licensee agreed to clear out all the hazzards and secure the construction area to ensure the safety of the clients, staff, and visitors. Licensee will submit incident report detailing the construction plan and what measures will be put in place to ensure clients safety. Licensee will provide photos and images of the area under construction by POC date showing it is free from hazzards.

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: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC809 (FAS) - (06/04)

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