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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208860
Report Date: 11/13/2024
Date Signed: 11/13/2024 02:31:57 PM

Document Has Been Signed on 11/13/2024 02:31 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:A PLUS BOARD AND CARE HOMEFACILITY NUMBER:
107208860
ADMINISTRATOR/
DIRECTOR:		TIBURCIO, RAULFACILITY TYPE:
740
ADDRESS:6757 E. CHRISTINE AVENUETELEPHONE:
(559) 293-4748
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 4DATE:
11/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Raul Tiburcio, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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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.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
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
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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Document Has Been Signed on 11/13/2024 02:31 PM - It Cannot Be Edited


Created By: Rachel A Bruce On 11/13/2024 at 02:11 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: A PLUS BOARD AND CARE HOME
FACILITY NUMBER: 107208860

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
Section Cited
CCR
87303(a)

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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:
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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.
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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.
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Type B
11/13/2024
Section Cited
CCR87555(b)(26)

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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:
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AD had staff replenish food supply while LPA was conducting visit. Plan of correction to be cleared at today's visit.
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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.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2024


LIC809 (FAS) - (06/04)
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