A Plus Assisted Living for Elderly

Type of visit: Required - 1 Year

On June 27, 2025 Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced to conduct the required one year annual inspection. LPA was greeted by caregivers attending to resident lunches. The Administrator Raul Tiburico was called and arrived shortly. Currently the home has six residents and the home contains 6 bedrooms and 4 bathrooms. Smoke and carbon monoxide detectors (combo alarm) tested and operational; they are hardwired to the other smoke detectors in the bedrooms and common areas. LPA observed all sounded when one was tested. There is one fire extinguisher located in the kitchen which was last serviced in July 2024. The first aid kit is located in kitchen next to the fire extinguisher and contained required items. Living room has screened fireplace with stove insert which is non-operational. LPA observed adequate seating in living room for six residents and a dining table with seating for 5 and also available seating around the counter/bar in the kitchen adjacent to the table. There is also a common area to use for resident recreation. In that room are yard toys, pool table, computer and piano. Kitchen observed to be to have appliances in good repair. Dishware and utensils sufficient for 6 residents observed. Knives are stored in a locked drawer in the kitchen. Medications are centrally stored in locked kitchen cabinet. Pantry observed to contain 7 day supply of non- perishable and emergency supply of food. 2 days of perishable food observed and stored appropriately in kitchen. Ample supply of linens, towels and toiletries, including incontinence pads observed in hall closets. Facility thermostat observed to be 72 degrees. Facility is maintained at a comfortable temperature. There are three temperature control zones in the home. Bedroom 1 has a private bathroom, water temperature measured within regulatory range. Bathroom has grab bars at the toilet and in the shower. Non- Skid mat available. Toilet flushed and is functioning. LPA observed room to be furnished with full size bed, dresser, night stand, trash can with lid. It was noted that water pressure when using the hottest setting is a little weak. Bathroom 1 observed to have required items, Shower and toilet grab bars installed, raised toilet seat, supply of paper towels, toilet paper and covered waste container. Water temp measured within regulatory range. . Bedrooms 2-6 observed to have sufficient space and were furnished with required furniture. Windows operable with screens in good condition. Bedroom 3 has been allocated as a bedridden room with fire door accessible to the outside. Bathroom 3 located in hallway observed to have grab bars in shower and next to toilet, non- skid mat. Bathroom is clean and in good condition. The bathroom in bedroom 4 observed to have functioning toilet, shower and toilet grab bars and non- skid mat, trash can with lid. Water pressure in sink faucet is normal. Water temperature in all bathrooms is within regulatory range. Laundry room has a locked door to the hallway and staff access the laundry room from backyard door, which is also kept locked. LPA observed washer and dryer and detergents and cleaning supplies in cabinets. There is an extra closet/storage area that remains locked and is used for staff personal items, not accessible to residents. Per Licensee, the garage area is kept locked and inaccessible to residents. Garage contains extra hygiene supplies, extra furniture and miscellaneous items. Licensee has sectioned a locked portion of the garage to contain gardening tools. Facility has a staff room, that will be accessible to residents as it is in an open space. The Licensee has divided the backyard with a combination of chain link fence, wood plank fence and iron fence. The portion of the yard allocated for residence is paved and has two wheelchair ramps on either side leading to lower portion of the yard. The rear portion on the yard that is fenced off contains a swimming pool and overgrown grass/weeds. This fencing has one self latching gate with a combination lock and door alarm. Fencing varies in height from 5' to approximately 6 feet all around. Side gate is self closing and self latching. There is a covered patio which supplies shade. There is a garden area adjacent to the ramps for the residents to grow seasonal fruit and/or vegetables. LPA conducted review of staff and resident files. All were found to be in compliance with CCR regulations. Staff files are located in locked office in hallway and the resident files were located in a locked built in cabinet in the common area. An exit interview was conducted and a copy of this report was left with Applicant, whose signature confirms receipt of these documentsthe state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Lissett Padgett arrived announced to conduct a Pre-Licensing inspection. LPA met with Licensees Raul Tiburcio and Connie Tiburcio. Home has 6 bedrooms and 4 bathrooms. Licensees are requesting capacity of 6 residents. Home and grounds toured with Licensees. Smoke and carbon monoxide detectors (combo alarm) tested and operational; they are hardwired to the other smoke detectors in the bedrooms and common areas. LPA observed all sounded when one was tested. Living room has screened fireplace with stove insert. Licensee states they will not be using the fireplace. LPA observed a love seat and two chairs in the living room and a dining table with seating for 4. Kitchen observed to be to have appliances in good repair. Refrigerator temp measured at 35 degrees F. Dishware and utensils sufficient for 6 residents observed. Knives are stored in lock box on kitchen counter. Medications will be centrally stored in designated to locked kitchen cabinet. Pantry observed to have adequate supply of dry goods and emergency supply of food. Ample supply of linens, towels and toiletries, including incontinence pads observed in hall closets. Facility thermostat observed to be 69 degrees. Licensees explained that HVAC unit is not functioning. Bedroom 1 has a private bathroom, water temperature measured 113.5. Bathroom has grab bars at the toilet and in the shower. Non Skid mat available. Toilet flushed and is functioning. LPA observed room to be furnished with full size bed, dresser, night stand, trash can with lid. Bathroom 2 observed to have required items, Shower and toilet grab bars installed, raised toilet seat, supply of paper towels and toilet paper. Water temp measured at 115.0 degrees F. Bedrooms 2-6 observed to have sufficient space and were furnished with required furniture. Windows operable with screens in good condition. Bedroom 3 has been allocated as a bedridden room. Bathroom 3 located in hallway observed to have grab bars in shower and next to toilet, non skid mat. LPA observed shower tub to have orange mold and the tub was dirty. Shower curtain also had orange mold and felt slimy. The bathroom in bedroom 4 observed to have functioning toilet, shower and toilet grab bars and non skid mat, trash can with lid. The water in the sink faucet comes out slow and less than pencil width. Licensee explained that he will repair this faucet. Laundry room has a locked door. LPA observed washer and dryer and detergents and cleaning supplies in cabinets. Per Licensee, the garage area will be kept locked and inaccessible to residents. Garage contains extra hygiene supplies, extra furniture and miscellaneous items. Licensee has sectioned a locked portion of the garage to contain gardening tools. The Licensee has divided the backyard with a combination of chain link fence, wood plank fence and iron fence. The portion of the yard allocated for residence is paved and has two wheelchair ramps on either side leading to lower portion of the yard. The rear portion on the yard that is fenced off contains a swimming pool and overgrown grass/weeds. This fencing has one self latching gate with a combination lock and door alarm. Fencing varies in height from 5' to approximately 6 feet all around. Side gate is self closing and self latching. The following observed will need to be brought into compliance prior to licensure: 1. HVAC repair so that the Air Conditioning and Heating are functioning. 2. Clean shower in bathroom 3 to remove mold and replace shower curtain 3. Telephone service must be functioning 4. Remove licensee personal items/clothing from hall closet 5. Seating for at least 6 residents in the living room 6. seating for at least 6 residents at the dining room table 7. Move bed in room 2 so that it does not obstruct the window. 8. Set up room allocated as the Staff Lounge Area, so that the approximately 6" step down does not pose a fall risk to residents. 9. Repair bathroom sink water faucet in bedroom 4 so that a full stream of water comes out. A follow-up inspection to be scheduled once all above items are in compliance. Exit interview conducted. A copy of this report was given to Licensees, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Apr 26, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Connie D Tiburcio CEO/ Raul Tiburcio Administrator Interview Method: Telephone interview On February 21, 2024, 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, Feb 21, 2024