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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412798
Report Date: 04/14/2023
Date Signed: 04/14/2023 02:14:36 PM


Document Has Been Signed on 04/14/2023 02:14 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AFFINITY SENIOR LIVING 1FACILITY NUMBER:
336412798
ADMINISTRATOR:ANALISA CAYABYABFACILITY TYPE:
740
ADDRESS:68842 RISUENO ROADTELEPHONE:
(760) 322-7905
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:10CENSUS: 9DATE:
04/14/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Analisa Cayabyab, AdministratorTIME COMPLETED:
02:17 PM
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On April 14, 2023, Licensing Program Analyst (LPA) Jesse Gardner and Licensing Program Manager (LPM) Joel Esquivel conducted an announced informal meeting also in attendance was the Administrator Analisa Cayabyab.

Items discussed during this informal meeting were:
  • Recent complaint concerns
  • Resident does not have proper storage space for personal belongings
  • Facility lacks night supervision for residents with dementia
  • Facility staff use restraint on resident at night to prevent them from wandering
  • Licensee has three residents sharing room


During this meeting it was stated that the licensee, Rita Wong could not attend due to personal injury. Administrator Analisa Cayabyab stated that she would provide a copy of the report to Ms. Wong. Ms. Wong will provide response to CCL by April 17, 2023, regarding the issues discussed.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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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