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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412698
Report Date: 01/03/2025
Date Signed: 01/03/2025 12:14:28 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/03/2025 12:14 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/
DIRECTOR:		ANALISA CAYABYABFACILITY TYPE:
740
ADDRESS:28200 HORIZON ROADTELEPHONE:
(760) 864-3259
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 9TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Analisa Cayabyab, administratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Anaylst (LPA) Seo Jeon, 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 in year 2023 and had informed the department of resident relocation. LPA conducted a walk through of the home, observed the home currently does not house any residents and is awaiting completion of renovation. The facility is a single story home with 6 bedrooms and 3 bathrooms with attached garage. There is a fenced swimming pool in the backyard awaiting completion of its gates. The facility administrator stated they are in the final stage of renovation. 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.
Rikesha StampsTELEPHONE: (951) 212-0616
Seo JeonTELEPHONE: 951-248-0309
DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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