A Plus Board and Care Home

Type of visit: Required - 1 Year

On 11/15/2025 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA was greet by staff and allowed entrance into the facility. Administrator Raul Tiburcio was contacted and arrived shortly after. LPA observed the residents to be sleeping in their rooms. Facility is licensed for a capacity of 6 with a current census of 4. Facility has 6 bedrooms and 3 bathrooms. Residents all have their own rooms and are properly furnished. LPA observed the facility to be clean, pest free, odor free, and clutter free. LPA observed all fire exits to be clear and free from obstruction. Smoke & Carbon monoxide reader was tested and are in working order. Water temperature was tested in a common bathroom and read at 109.5. Fire extinguisher was last serviced 7/3/2025 and still holds charge. LPA observed chemicals, cleaning supplies, and knives to be locked and inaccessible to residents in case. LPA reviewed a sample of staff files for current staff working at the facility. These files are current an up to date. Administrator's certificate is current. LPA reviewed a sample of resident files. LPA reviewed medications and did not find any medication errors at this time. Administrator will provide requested documents by end of day 11/18/2025. If documents are not provided on time a case management visit will be warranted at a later time. Exit interview was conducted and a copy of this report LIC 809 was printed and provided to Administrator Raul Tiburcio.the state’s words, verbatim · CDSS document, Nov 15, 2025

Type of visit: Case Management - Deficiencies

On 11/13/2024, Licensing Program Analyst (LPA) Rachel Bruce conducted an announced inspection at the facility. LPA was welcomed by Administrator (AD) Raul Tiburcio and was provided a tour of both the interior and exterior of the home. Inspection revealed in the backyard that there is an unfenced section on the side of the house that is being used to store unusable furniture and other miscellaneous items that need to be removed from the premises. AD understood the potential danger to the residents and will remove the items by end of the week Inspection also revealed that food supply was not within regulations. There was 2 days worth of perishable items but there was not a 7 day supply of non-perishable items to accommodate the 4 current residents. AD understood the need to have more supplies on hand and will have the supply replenished by end of day. See attached Deficiency Page.the state’s words, verbatim · CDSS document, Nov 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 15, 2024

Maintenance and Operations: (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: There is an area in the backyard being used to store non-functioning and unusable items that are waiting to be destroyed or removed from the property. This storage is unsafe and poses a potential risk to the health and safety of the residnets in care.the state’s words, verbatim · CDSS document, Nov 13, 2024

Plan of correction: AD stated he will get rid of the items stored in that area and will clean up that section of the yard by Monday, November 15, 2024. AD will submit photographs to LPA of the completed work.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(26) · Plan of correction due date: Nov 13, 2024

General Food Service Requirements: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: There was sufficient perishable foods for two days but there was insufficient nonperishable food inventory to meet the seven day requirement. This poses a potential risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2024

Plan of correction: AD had staff replenish food supply while LPA was conducting visit. Plan of correction to be cleared at today's visit.

Type of visit: Required - 1 Year

On 11/13/2024, Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced at the facility for the purpose of conducting an annual inspection. LPA was met by Raul Tiburcio, Administrator (AD) and was provided a tour of both the interior and exterior of the home. LPA explained the purpose of the visit and AD had no questions. The home has 6 bedrooms, 2.5 bathrooms, an office lounge area, a garage being utilized for storage and currently a vacant bedroom is being used for office and storage. Currently there are 4 residents, 3 non- ambulatory and 1 ambulatory. LPA observed the bedrooms to be clean and orderly and all had appropriate furnishings meeting regulatory requirements. All bedrooms are private. In the resident bathrooms LPA observed required items, non slip mat and grab bars. LPA was unable to test hot water temperature as thermometer was broken. Temperature felt appropriate to the touch but cannot be confirmed at the time of the inspection. Resident hygiene supplies were properly stored and available. The kitchen was toured and observed to be in good repair with necessary items and appliances. Dishware and utensils sufficient for 6 residents observed Sharps and knives were properly stored and were locked and inaccessible. LPA observed food supply and found that there was sufficient perishable items meeting the 2 day requirement however, there was not 7 days of non-perishable food available. This will be addressed separately in a case management report dated 11/13/2024.. Medication records were reviewed and found to be accurate and updated. Pill count was conducted and no errors found. Medications are centrally stored and locked in a cabinet located in the kitchen. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors. The self latching gate at the side of the house has to be manually closed as the wood has swollen. AD to remedy that by trimming gate or rehanging. First aid kit located in kitchen cabinet and found to contain required items. Fire Extinguisher also located in the kitchen was serviced in February 2024. Smoke and carbon monoxide detectors (combo alarm) tested and found to be operational; they are hardwired to the other smoke detectors in the bedrooms and common areas. LPA observed all sounded when one was tested. LPA conducted resident and staff file reviews. LPA chatted briefly with residents that were able to communicate and no resident brought up any issues or concerns. Administrator’s re-certification was confirmed to be in pending status.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with Administrator Raul Tiburcio (AD) and explained the purpose of the visit. Facility was toured with AD. During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting in 3 of the 4 bedrooms. LPA is requesting an AD submit and exception for furniture not available in R1’s bedroom. LPA observed required items in two resident bathrooms with hot water measuring 109.1 and 116.8 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required food supply and paper products. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors, gate was found to be in working order. First aid kit located in locked cabinet in kitchen and found to contain required items. Fire Extinguisher located in the kitchen was serviced on 7/6/2023. Smoke and Carbon Monoxide detectors are tested found to be operational. LPA conducted resident and staff file reviews and interviews. Administrator’s re-certification was confirmed to be in active status. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 1/19/2024: Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Exemption Request Letter, staff training verification.the state’s words, verbatim · CDSS document, Jan 12, 2024