107208860-12-3-2024-24-AS-RABE-DAYUL3-20241113144006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107208860
Report Date: 11/13/2024
Date Signed: 12/03/2024 10:45:17 AM

Document Has Been Signed on 12/03/2024 10:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	A PLUS BOARD AND CARE HOME		FACILITY NUMBER:	107208860
ADMINISTRATOR/ DIRECTOR:	TIBURCIO, RAUL		FACILITY TYPE:	740
ADDRESS:	6757 E. CHRISTINE AVENUE		TELEPHONE:	(559) 293-4748
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	11/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Raul Tiburcio, Administrator		TIME VISIT/ INSPECTION COMPLETED:	02:30 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	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.

Sergiy Pidgirny	TELEPHONE: (559) 246-0610
Rachel A Bruce	TELEPHONE: (559) 470-9001
	DATE: 11/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: A PLUS BOARD AND CARE HOME	FACILITY NUMBER: 107208860
	VISIT DATE: 11/13/2024

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
26
27
28
29
30
31
32

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.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A Bruce	TELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2