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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412698
Report Date: 06/06/2025
Date Signed: 06/06/2025 10:32:24 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
04/22/2021 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210422092430
FACILITY NAME:AFFINITY SENIOR LIVING 2FACILITY NUMBER:
336412698
ADMINISTRATOR:ANALISA CAYABYABFACILITY TYPE:
740
ADDRESS:28200 HORIZON ROADTELEPHONE:
(760) 864-3259
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:9CENSUS: 0DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Analisa CayabyabTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff are not providing residents' medications.
Staff are not ensuring that residents are hydrated.
Staff are not following residents' care plans.
Staff are not seeking residents' timely medical attention.
Staff are not allowing residents to receive medical services.
Residents are unable to effectively communicate with care providers due to a language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings for 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 there are no current staff or residents in care. The investigation consisted of interviews and file review. The facility experienced a natural disaster which resulted in loss of facility records, therefore facility records were unable to be reviewed.

It was alleged “Staff are not providing residents' medications.” It was alleged Resident #1 (R1) was only being provided with vitamins and was not provided with their prescribed medications. Interview with R1 revealed they were being provided with their prescribed medications.
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)
Page: 1 of 3
Control Number 18-AS-20210422092430
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 (1) staff who provided care to R1 revealed they provided R1 with their prescribed medications. Interviews with additional staff and residents 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 not provided with their prescribed medications is unsubstantiated.

It was alleged “Staff are not ensuring that residents are hydrated.” It was alleged R1 was hospitalized (4) times due to dehydration. It was alleged the facility did not prevent dehydration for residents. Department staff interviewed (4) residents. Interview with R1 revealed all their needs were being met at the facility. Interview with (2) of (4) residents stated they were being provided with water and their needs were being met by staff. On 04/23/2021, department staff observed residents with water at their bedside. Interview with (1) administrative staff revealed R1 was being fed plenty of fluids. Interviews with additional staff were unable to be conducted due to no contact information being available. No records for R1 were retained by the facility. Therefore, the allegation that staff had not prevented dehydration of residents is unsubstantiated.

It was alleged “Staff are not following residents' care plans.” It was alleged that the administrator was making false statements about the care residents required and was not following the resident’s care plans. LPA conducted interview with the administrator who denied they were making false statements on the resident’s care and all care plans were up to date and followed. Additional staff interviews were unable to be conducted due to no contact information being available. Department staff conducted (4) resident interviews. (2) of (4) residents revealed all their needs were being met. No records for residents or staff were retained by the facility. Therefore, the allegation the facility staff made false statements on the resident's care plans is unsubstantiated.

It was alleged “Staff are not seeking residents' timely medical attention.” It was alleged staff did not call 911 when a resident was experiencing left arm pain. No information on the dates or resident affected was provided. Department staff conducted interviews with (4) residents.

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)
Page: 2 of 3
Control Number 18-AS-20210422092430
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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(3) of (4) residents stated all their care needs were being met by staff and staff provide assistance with emergency medical attention. Interview with (1) staff revealed assistance was provided to all residents, including calling 911 for medical emergencies. Additional staff interviews were unable to be conducted due to no contact information being available. No records for residents were retained by the facility or able to be reviewed. Therefore, the allegation that staff are not assisting residents with timely medical attention is unsubstantiated.

It was alleged “Staff are not allowing residents to receive medical services.” It was alleged the administrator was not allowing Resident #2 (R2) and other residents to see a physical therapist. Department staff conducted (4) resident interviews. R2 was not alert and oriented during the interview. Interview with (2) of (4) residents revealed that all their care needs were being met. Interview with the administrator revealed R2 was evaluated by a physical therapist and deemed incompatible based on their condition. Additional staff interviews were unable to be conducted due to no contact information being available. No records for residents were retained by the facility or able to be reviewed. Therefore, the allegation that R2 and other residents were not permitted to see a physical therapist is unsubstantiated.

It was alleged “Residents are unable to effectively communicate with care providers due to a language barrier.” Department staff conducted (4) resident interviews. (3) of (4) residents revealed there is no language barrier with staff. Interview with (1) staff revealed all staff working for the facility were able to speak English and communicate with residents. Additional staff interviews were unable to be conducted due to no contact information being available. No staff records were retained by the facility or able to be reviewed. Therefore, the allegation that staff are unable to communicate with residents 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 reviewed and 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)
Page: 3 of 3