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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412698
Report Date: 03/14/2026
Date Signed: 03/14/2026 04:10:35 PM

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
03/01/2023 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230301101659
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: 6DATE:
03/14/2026
UNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Nilda Agtang CaregiverTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff neglect caused resident to develop a pressure injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Caregiver Nilda Agtang who assisted with today’s visit. Administrator Analisa Cayabyab arrived shortly.

The investigation consisted of the following: During the initial visit conducted on 03/09/2023, (LPA) Jesse Gardner conducted an unannounced visit to the facility to initiate a complaint investigation. LPA identified himself and met with Lilia Cayabyab. LPA discussed the purpose of the visit and toured the facility. Administrator Analisa Cayabyab arrived while LPA was inside the facility. LPA interviewed staff and gathered related documents. On 03/11/2026 LPA conducted a pre investigation and interviewed witness #1(W1) and contacted hospice center along with Riverside Regional Office. During today’s visit LPA Gutierrez obtained resident roster, staff roster and reviewed four (4) residents files. LPA interviewed Administrator, staff #1- staff #2 (S1-S2) and residents 2-4 (R1-R5) and delivered findings.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026
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-20230301101659
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: 03/14/2026
NARRATIVE
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In regard to the allegation” Staff neglect caused resident to develop a pressure injury “, It is alleged that staff neglect caused resident to develop a pressure injury. During interview with Administrator, and staff all three (3) stated that there has never been staff neglect and no resident has sustained any pressure injuries due to staff neglect. Interview with Administrator revealed that R1 had a boil that hospice was aware of and treating there was never any documents stating that it was a pressure injury. R1’s paperwork was destroyed when house had flood damage caused by storm Hilary in 2023 furthermore resident moved out February 25th,2023 and Per section 87506(e) Resident Records Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. LPA contacted witness #1 and asked for any documents to be sent via email and LPA received pictures and hospice care center information. LPA contacted hospice care center provided by W1 and they are no longer in service LPA reviewed four (4) residents’ files and did not see any doctor or hospital paperwork indicating untreated pressure, injuries or wounds. All four files reviewed indicated residents are receiving hospice care and no reports of any pressure injuries are indicated in there hospice folders. R2 is being treated for a foot wound that he/she was admitted to the facility with but is being treated correctly and notated by hospice agency. During interviews with residents three (3) out of four (4) stated they have never developed any pressure injuries and staff does not neglect them. R3 stated that he /she has a button and when pressed staff comes. One (1) resident was confused by questions and did not answer LPA.

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. An exit interview was conducted with Nilda Agtang Caregiver, and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2