Duraliza Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Rhonald Aranzaso. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 4 residents and 2 staff were observed in the facility. LPA reviewed 3 resident file and 3 staff files. Living room, kitchen, dining room, 2 restrooms, and garage were inspected. 4 resident bedrooms were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Dish washing solution bottle was observed on the kitchen sink counter, ADM locked it immediately. Room temperature was at 72 degree F, and hot water temperature was at 110 degree F in facility. The temperature of the refrigerator was at 37 degree F, and the temperature of the freezer was at 0 degree F. Fire extinguisher was serviced on 01/09/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency and fire drill was on 01/05/2026. No citation noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Jan 15, 2026

Allegation investigated: Resident's pressure injury progresses to an unstageable wound due to staff neglect of adhering to the wound care plan.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with House Manager (HM) Mary Rose Sumbi. On 07/03/2025, the Department received a complaint with the allegation Resident's pressure injury progresses to an unstageable wound due to staff neglect of adhering to the wound care plan. On 07/07/2025, the Department conducted an initial visit and requested resident R1's pre assessment form, physician report, appraisal needs and service plan, daily activity log, and incident reports. Continue on LIC9099-C. Page 1 of 3. Unsubstantiated On 06/10/2025, resident R1 was found with pressure wound on coccyx and bilateral hips. On 6/11/2025, R1 was sent to urgent care. R1 was diagnosed stage 2 or stage 3 pressure wound and was prescribed with cream for 7 days. Home health services was recommended to treat R1's pressure wound. R1 returned to the facility on the same day. A doctor appointment was made with R1's Primary Care Physician on 6/25/2025. On 06/16/2025, home health service agency contacted the facility to schedule a wound care appointment, but R1 was admitted to hospital emergency room due to R1's fainting on the same day. The hospital noted R1's pressure wound was unstageable. On 6/28/2025, R1 was discharged from hospital to a skilled nursing facility. On 07/10/2025, the Department interviewed Administrator (ADM) Rhonald Aranzaso. ADM stated on a yearly basis, the facility staff attend 16 hours of regional center mandatory training including recognition and avoidance of pressure ulcers. ADM stated R1 has been living at the facility since year 2016 and was able to ambulate independently with a walker until March 2024. ADM stated R1 received 1:1 care 6 hours per day since March 2024. ADM stated in June 2025, R1's care was promoted to be a two-person assist. ADM stated on 06/11/2025, the urgent care doctor recommended home health service to treat R1' pressure ulcers. ADM stated from 06/11/2025 to 06/16/2025, the facility staff followed R1's pressure ulcer wound care plan dated October 2024 created by regional center nurse. ADM stated the facility staff kept R1 hydrated by offering water throughout the day and to constantly encourage R1 to reposition. Staff applied barrier creams to the area with redness and applied skin barrier cream to all diapers to wear. ADM stated Home health service agency contacted the facility on 6/16/2025 to schedule appointment for R1, but R1 was admitted to hospital emergency room on 06/16/2025. On 7/17/2025, the Department interviewed 2 staff (S1, S2). Both stated R1 was found with redness on coccyx on 6/10/2025 and was sent to urgent care on 6/11/2025. Both stated they followed R1's pressure ulcer care plan dated in October 2024 to take care of R1's pressure ulcers from 6/11/2025 to 6/16/2025 until R1 was sent to hospital ER due to fainting. S1 stated he/she contacted home health service agency. S2 stated he/she constantly attempted to reposition R1 using wedge pillows and constantly offering R1 with fluids, and applied creams to the ulcer during diaper change. Continue on LIC9099-C. Page 2 of 3. On 08/12/2025, the Department interviewed 2 staff (S3, S4). Both stated they followed R1's pressure ulcers care plan dated in October 2024 to take care of R1's pressure wound. Both stated they constant repositioning R1, changing R1's diaper, keeping hydration of R1. Both stated they received regional center yearly training including pressure ulcers. Based on the interview and record reviewed, the facility staff provided the care based on R1's pressure ulcers care plan for R1's pressure ulcers and arranged the home health service to take care of R1's pressure ulcers. The care the facility staff provided including constant reposition, frequent diaper changes, hydration with liquid, applying skin barrier creams, and changing the dressing. On 6/16/2025, R1 was sent to emergency room due to fainting, so R1's home health service was unable to start. R1's resistant to reposition and threw the wedge pillows away preventing R1 from healing. There is no evidence to show R1's unstageable wound is due to staff neglect. Based on investigation, interviews conducted and records reviewed , the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s compliant investigation visit. Exit interview conducted with HM. The report was provided to HM for review. A copy of this report was provided to HM. Page 3 of 3.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 26-AS-20250703194452

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) conducted an unannounced case management visit and met with Administrator (ADM) Rhonald Aranzaso. On 7/3/2025, the Department received a report regarding resident R1's incident. On 7/7/2025, LPA interviewed Administrator (ADM) Rhonald Aranzaso. ADM stated resident R1 moved in the facility on 4/1/2016. ADM stated based on the R1's pre assessment dated 2/29/2016, R1 was ambulatory, able to reposition self, and without any pressure injury. ADM stated R1 was unable to walk by self in 2023 and was with cognitive impairment in 2023, but R1 still was able to reposition self and without pressure injury. ADM stated on 10/30/2024, R1 had stage 1 wound. ADM stated the facility consult with the facility RN consultant and developed care plan for R1's wound. ADM stated R1's wound was healed on 11/28/2024. ADM stated on 6/11/2025, the facility staff found R1 had wound and brought R1 to urgent care. ADM stated the urgent care prescribed ointment and Silicon Foam dressing for R1 and to consult home health agencies to take care of R1's wound. ADM stated he/she contacted 2 home health care agencies. ADM stated the facility staff take care of R1's wound based on R1's wound care plan. ADM stated on 6/16/2025, R1 was passed out in the restroom with 2 staff. 911 was called and R1 was sent to hospital emergency room. On 6/19/2025, R1 was transferred from hospital ICU to regular room. Continue on LIC809-C. Page 1 of 2. ADM stated on 6/27/2025, the facility had a care conference with hospital and SARC, and decision was made to discharge R1 to skilled nursing facility for rehabilitation and wound care. ADM stated on 7/7/2025, R1 is still at the skilled nursing facility. LPA interviewed 3 staff. 3 out of 3 staff stated they saw R1 had redness on the hip before 6/11/2025 the date R1 was sent to urgent care. 3 out of 3 staff stated the applied cream to R1's redness area based on the facility care plan. LPA requested R1's pre assessment form, physician report, appraisal needs and service plan, daily activity log, and incident reports. LPA observed 3 staff and 1 residents in the facility. This case needs further investigation. Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Jul 7, 2025

Allegation investigated: The facility is physically abusing the resident The facility is verbally abusing the resident

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 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.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 26-AS-20250313154002

Type of visit: Required - 1 Year

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 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.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Office

On 12/20/2024 Licensing Program Analysts Marcela Yanez and Simi Rai and Licensing Program Manager Romeo Manzano met with Administrator Rhonald Aranzaso and Applicant Estela Pendon in the office to follow up with their transition plan upon the death of licensee and discussed required documents. Ms. Pendon provided CCLD a copy of her mother's living trust to take over the corporation and also submitted LIC309, LIC308 and LIC500. Ms. Pendon is working on a new lease agreement with the landlord will submit a copy next week, and will submit a new board resolution appointing Mr. Aranzaso as the ADM. This report was reviewed with Administrator Rhonald Aranzaso and Corporation Officer Estela Pendon and a copy of the report was provided. No deficiency cited during visit.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Marcela Yanez and Simi Rai arrived to the facility unannounced to conduct a case management visit for a wellness check. LPAs met with Administrator ADM, Rhonald Aranzaso and stated the purpose of the visit. LPAs observed 2 out of 5 residents in living room watching television. 3 of 5 residents were at day program. LPAs toured the facility inside and out and observed the facility to be in accordance of regulation. LPAs toured the kitchen and pantry closet and observed 2 days of perishable foods and 7 days of nonperishable foods. LPAs observed residents' medications in the locked medication cabinet and no issues noted. LPAs toured 4 resident bedrooms and 2 bathrooms which were complete with bedding, dresser and proper lighting. ADM stated the staff will continue to provide care and supervision and no issues of staffing at this time. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Ronald Aranzaso and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

Type of visit: Required - 1 Year

On 12/20/23, Licensing Program Analysts (LPA) L. Salazar and LPA Doucette arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPAs were greeted by Staff, stated the purpose of the visit and was allowed entry into the facility. Administrator arrived to the facility a few minutes later. Staff provided a tour of the facility inside and out. Administrator on record is Rhonald S Aranzaso, Certificate #6023096740 Expires 01/2024. There are currently 6 residents in the home. The facility is a 5 bedroom / 2 bathroom home. No residents are receiving Hospice services or receiving Home Health care service. A sample of resident and staff files were reviewed and observed to have the required forms and training records. LPA toured the facility inside and out and observed the facility temperature read at 72 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Bathrooms were observed to have operational lights, running water, and non-slip floors. Hot water temperature tested at 148.4 degrees F. Facility turned down water heater in the presence of LPA's, which is measuring at 93.2 F. Facility will continue to check water heater to be in compliance. Required postings were observed for Non-discrimination LGBTQ-A+, Personal Rights of Residents in RCFE (87468.1 and 87468.2), facility's visitation policy and Complaint Poster. Cleaning supplies were observed to be locked in the garage . LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed. Carbon monoxide detectors were observed to be operational. Fire Extinguisher was observed with a service date of 06/22/23. First aid kits were observed to contain all required items. (Continued LIC 809-C) (Continued from 809) Medications were observed to be in a locked cabinet in the kitchen. Quarterly Emergency Disaster Drill logs were observed. Last drill was on 12/16/23. LPA is requesting the following documents be submitted to the Fresno CCL office by 01/05/2023: Designation of Facility Responsibility (LIC308), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance Emergency and Disaster Plan (LIC 610ES) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), copy of current Surety Bond. An exit interview was conducted with Administrator. A copy of this report, plans of correction and appeal rights were discussed and provided at the time of visit.the state’s words, verbatim · CDSS document, Dec 20, 2023