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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202414
Report Date: 04/01/2025
Date Signed: 04/01/2025 11:24:02 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2025 and conducted by Evaluator Marcela Yanez
COMPLAINT CONTROL NUMBER: 26-AS-20250313154002
FACILITY NAME:DURALIZA CARE HOMEFACILITY NUMBER:
435202414
ADMINISTRATOR:RHONALD ARANZASOFACILITY TYPE:
740
ADDRESS:1938 ENSIGN WAYTELEPHONE:
(408) 923-1160
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:6CENSUS: 6DATE:
04/01/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Mary Sumbi Lead StaffTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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The facility is physically abusing the resident
The facility is verbally abusing the resident
INVESTIGATION FINDINGS:
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On 04/01/2025 at 10:50 AM Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver the complaint findings. LPA announced the purpose of the visit. LPA met with Lead Staff Mary Sumbi, ADM was contacted by phone.

On 03/13/2025 The department received a complaint for an alleged allegation that a resident is being verbally and or physically abused.

During the course of the investigation LPA Yanez obtained records for 3 residents which included Physicians Report, Appraisal Needs and Services Plan, IPP and daily progress notes. LPA Yanez interviewed 3 staff and 1 resident.

Page 1 of 2
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 26-AS-20250313154002
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/01/2025
NARRATIVE
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On 03/21/2025 LPA reviewed documentation for R1-R3. R1 record states a diagnosis of Dementia and hallucinations. LPA reviewed daily progress notes with dates and time that resident is self-talking and shouting and cursing on 03/04/25-03/06/25. R1 after visit summary dated 03/04/25 doctors summary states residents’ medication was increased to control behavior.

LPA toured the facility and interviewed 3 staff including the ADM and 2 direct support staff. ADM stated that R1 and R2 do not like each other and constantly tell each other to be quiet. ADM stated that R1 has night behavior and hallucinations, which is indicated on R1 progress notes. ADM stated that the behavior has become more severe in the past month. ADM indicated on doctors after visit summary and R1s medication was increased to control behavior. ADM provided doctors notes showing the medication increase.

S1 stated that the R1 and R2 do not get along. S1 stated that R2 is very independent and does not like any form of yelling and or shouting that R1 does when having behavior. S2 stated that R1 has behavior and throws pillows and screams and curses. S2 stated R2 tells R1 to be quiet when R1 screams.

LPA interviewed Witness (W1) that stated resident is having behavior and is hallucinating with food and seeing things that are not there like people.

During visit LPA interviewed R1, R1 is hard of hearing and is unable to answer basic questions. R1 is very vocal and likes to shout. LPA observed this during visit on 03/21/25 and 04/01/25.

The Department has investigated the above allegations. Based on interviews, record review and observation the above allegations are unfounded meaning the allegations is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Mary Sumbi, Lead Staff and a copy of the report was provided.

Page 2 of 2. End of Report.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC9099 (FAS) - (06/04)
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