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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336410667
Report Date: 04/23/2026
Date Signed: 04/23/2026 11:53:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2026 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20260417140210
FACILITY NAME:DOLORES HOMECAREFACILITY NUMBER:
336410667
ADMINISTRATOR:ANALISA CAYABYABFACILITY TYPE:
740
ADDRESS:30758 BLOOMSBURY LANETELEPHONE:
(760) 202-6609
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:4CENSUS: 3DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Analisa Cayabyab, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff speak inappropriately to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to investigate the above allegation. LPA met with Analisa Cayabyab, Administrator and informed them of the purpose of the visit. The Department’s investigation involved interviews with staff and residents and review of records.

On April 17, 2026, Community Care Licensing (The Department) received a complaint report with the following allegation.

It was alleged that staff speak inappropriately to resident. Information received indicated that Staff #1 (S1) called names and used inappropriate languages to Resident #1 (R1). LPA’s review of R1’s resident file revealed that R1 had cognitive condition and resided here since May 2025. LPA conducted an interview with R1, who stated that S1 used foul languages while S1 was providing care to R1. R1 heard S1 using foul languages a few times in the past several months. Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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 18-AS-20260417140210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DOLORES HOMECARE
FACILITY NUMBER: 336410667
VISIT DATE: 04/23/2026
NARRATIVE
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R1 stated S1 has not been around for a few months now. R1 stated there were no health and safety concerns. LPA conducted interviews with two (2) other residents, all of whom denied experiencing staff members speaking inappropriately in the facility. LPA conducted an interview with the Administrator who stated that S1 has always followed the residents’ care plans and spoke to residents in professional manner. LPA conducted an interview with S1 who stated that S1 has never spoken inappropriately or heard any staff members speaking inappropriately to residents in care.

Based on interviews conducted and file review, the Department’s investigation did not provide enough information to corroborate the allegation that staff speak inappropriately to resident. This allegation is unsubstantiated.



A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2