<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202414
Report Date: 01/16/2025
Date Signed: 01/21/2025 11:56:44 AM

Document Has Been Signed on 01/21/2025 11:56 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:DURALIZA CARE HOMEFACILITY NUMBER:
435202414
ADMINISTRATOR/
DIRECTOR:		RHONALD ARANZASOFACILITY TYPE:
740
ADDRESS:1938 ENSIGN WAYTELEPHONE:
(408) 923-1160
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY: 6CENSUS: 5DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Rhonals AranzasoTIME VISIT/
INSPECTION COMPLETED:
05:45 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) Marcela Yanez and Christine Dolores-Kabarati conducted an unannounced Required 1 Year visit and met with Rhonald Aranzaso, Administrator (ADM). LPAs announced the purpose of the visit. LPAs observed 4 out of 5 resident and 2 staff.

During visit, LPAs toured the facility inside and out. LPA observed the room temp was 69 degrees F. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications and sharp objects. The cabinet in the laundry room which supplied cleaning supplies were observed unlocked. Based on record review of 3 resident files, 1 out of 3 residents were at risk if allowed direct access to hygiene products. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days.

LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detectors in the hallway and found the smoke detector to function properly when tested by the administrator. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer 109 to 119 degrees F.

LPA observed bathroom #1 had the toilet seat missing and in disrepair and LPA also observed ants in the shower area (pictures taken). During visit, staff repaired the toilet seat. Staff cleaned the ants in the bathroom.

LPAs inspected the backyard and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 06/22/2023. Fire and earthquake log was reviewed and last disaster drill was on 1/10/25. LPA inspected the first aid kid and found to be complete with tweezers and gauze and first aid guide. Page 1 of 2
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: DURALIZA CARE HOME
FACILITY NUMBER: 435202414
VISIT DATE: 01/16/2025
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
LPA observed spoiled fruit which contained mold fallen from tree on backyard patio area and accessible to residents in care. ADM states the residents use the backyard at least once a day. ADM was advised to ensure the moldy fruits were cleaned up. During visit staff cleaned the fallen fruit from the ground.

LPA reviewed resident records for 3 out of 5 residents.. LPA reviewed 3 staff records and found them to be complete. LPA reviewed with ADM for 2 residents CSMDR and found to be complete.

LPA reviewed 2 out of 3 resident P & I money with ADM and staff. 1 out of 3 resident's did not have P&I money. LPAs observed 1 resident (R3) P&I money was not accurate as the actual cash total in the resident's money bag did not total to the balance in the resident's logs. LPAs observed the facility had multiple P&I logs for this resident as recommended by the San Andreas Regional Center (SARC), however, ADM stated this recommendation was only verbal. LPAs advised ADM to track the resident's P&I money on one log to avoid confusion, unless stated otherwise in the resident's IPP and/or appraisal/needs and services plan. ADM stated understanding.

Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Rhonald Aranzaso, Administrator (ADM) and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/21/2025 11:56 AM - It Cannot Be Edited


Created By: Marcela Yanez On 01/16/2025 at 05:20 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DURALIZA CARE HOME
FACILITY NUMBER: 435202414

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview the licensee did not comply with the section cited aboved by having an unlocked cabinet located in the laundry which contained disenfectats and chemicals which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
ADM stated they will conduct a in service training on how to maintain toxins locked in cabinet and out of reach of residents will submit POC by due date of 01/17/2025 via email.
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.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Marcela Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 01/21/2025 11:56 AM - It Cannot Be Edited


Created By: Marcela Yanez On 01/16/2025 at 05:23 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DURALIZA CARE HOME
FACILITY NUMBER: 435202414

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87217(g)
(g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review and interview, the licensee did not comply with the section cited above in not maintaining an accurate cash log for resident R3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2025
Plan of Correction
1
2
3
4
ADM stated they will combine all cash resources on one log for each resident and submit a written plan moving forward to maintain an accurate account for cash resources.
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.
SUPERVISOR'S NAME:Romeo Manzano
LICENSING EVALUATOR NAME:Marcela Yanez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4