336412698-6-6-2025-18-AS-APAO-DHGTJF-20250609144615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336412698
Report Date: 06/06/2025
Date Signed: 06/06/2025 10:31:34 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
06/10/2021 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210610081401

FACILITY NAME:	AFFINITY SENIOR LIVING 2		FACILITY NUMBER:	336412698
ADMINISTRATOR:	ANALISA CAYABYAB		FACILITY TYPE:	740
ADDRESS:	28200 HORIZON ROAD		TELEPHONE:	(760) 864-3259
CITY:	CATHEDRAL CITY	STATE: CA	ZIP CODE:	92234
CAPACITY:	9	CENSUS: 0	DATE:	06/06/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Analisa Cayabyab		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff administered medication to resident not prescribed by resident's physician.
Staff did not ensure resident was fed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings to the above allegations. LPA met with Administrator, Analisa Cayabyab, who was informed of the purpose of the visit. LPA conducted a walk through during the time of the visit and observed no current residents or staff. The investigation consisted of interviews and file review.The facility experienced a natural disaster which resulted in loss of facility records, therefore records review was unable to be conducted.

It was alleged “Staff administered medication to resident not prescribed by resident's physician.” It was alleged Resident #1 (R1) was being given sedation medication not prescribed by the resident’s physician by facility staff for (1) week.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210610081401

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: AFFINITY SENIOR LIVING 2	FACILITY NUMBER: 336412698
	VISIT DATE: 06/06/2025

NARRATIVE

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Interview with R1 revealed they were being provided with their prescribed medications. Interview with (1) staff revealed R1 was only provided with medications prescribed by their doctor. Staff denied R1 was given unprescribed sedative medication. Interview with (1) confidential witness revealed no concerns over the care R1 was receiving at the facility. Additional staff interviews were unable to be conducted due to no contact information being available. No records for R1 were retained by the facility or available for review. Therefore, the allegation that R1 was being given sedation pills that were not prescribed is unsubstantiated.

It was alleged “Staff did not ensure resident was fed.” It was alleged that R1 was not fed solid food for (3) days straight and was only given Ensure. It was alleged R1 lost 50 to 60 pounds while at the facility due to malnourishment. Interview with R1 revealed all their care needs were being met by staff. Interview with (1) administrative staff revealed R1 was on Hospice services and refused to eat, but was being provided Ensure. Interview with (1) confidential witness revealed no concerns over the care R1 was receiving at the facility. No records for R1 were retained by the facility or available for review. Therefore, the allegation that staff was not ensuring R1 was being properly fed is unsubstantiated.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

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