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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412698
Report Date: 01/12/2024
Date Signed: 01/12/2024 03:02:52 PM


Document Has Been Signed on 01/12/2024 03:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 2FACILITY NUMBER:
336412698
ADMINISTRATOR:ANALISA CAYABYABFACILITY TYPE:
740
ADDRESS:28200 HORIZON ROADTELEPHONE:
(760) 864-3259
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:9CENSUS: 0DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Administrator, Analisa CayabyabTIME COMPLETED:
03:20 PM
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Licensing Program Anaylst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to conduct an annual inspection. LPA met with Administrator, Analisa Cayabyab who was informed of the purpose of the visit.

The home experienced flooding of (4) feet the year prior and had informed the department of resident relocation. LPA conducted a walk through of the frame of the home, and observed the home currently does not house any residents and is awaiting renovations. The facility administrator stated they have gotten an evaluation of the damage and are securing a restoration company with estimated completion date of (6) months. The administrator stated once the renovations are completed, a new fire inspection will be conducted followed by notification to the department for additional facility walk through.

An exit interview was conducted with Administrator, Analisa Cayabyab where this report was reviewed and provided to them.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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