Affinity Senior Living 2

Allegation investigated: Staff neglect caused resident to develop a pressure injury

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 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.the state’s words, verbatim · CDSS document, Mar 14, 2026 · control 18-AS-20230301101659

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Nilda Agtang, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and five (5) residents present. Facility Overview: The facility is a one-story home with six (6) bedrooms and three (3) bathrooms, including an attached garage. There are no known firearms on the premises. There is a fenced swimming pool with locked gate that is in compliance with local regulation. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 106°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five (5) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed records for centrally stored medications for five (5) residents. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-20-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Seo Jeon conducted a licensee initiated visit to check on the facility's physical plant after 2 years of renovation due to flood damage caused by Storm Hilary in 2023. LPA met with Analisa Cayabyab, Licensee, who allowed LPA's entry. LPA was informed that there were no residents currently reside at this facility. There were no staff on duty during the time of the visit. LPA did not observe any residents residing or any sign of residency. LPA toured the facility and observed all facility utilities to be on and operating without issues. The food supply meets the 7-day non-perishables, and 2-day perishables regulatory requirement. LPA observed the facility's physical plant remained the same. LPA did not observe any health and safety concerns. No deficiencies are being cited and no civil penalties per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted where a copy of this report was discussed with and provided.the state’s words, verbatim · CDSS document, Jul 2, 2025

Allegation investigated: Staff administered medication to resident not prescribed by resident's physician. Staff did not ensure resident was fed.

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings to 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 no current residents or staff. The investigation consisted of interviews and file review.The facility experienced a natural disaster which resulted in loss of facility records, therefore records review was unable to be conducted. It was alleged “Staff administered medication to resident not prescribed by resident's physician.” It was alleged Resident #1 (R1) was being given sedation medication not prescribed by the resident’s physician by facility staff for (1) week. Unsubstantiated Interview with R1 revealed they were being provided with their prescribed medications. Interview with (1) staff revealed R1 was only provided with medications prescribed by their doctor. Staff denied R1 was given unprescribed sedative medication. Interview with (1) confidential witness revealed no concerns over the care R1 was receiving at the facility. Additional staff interviews 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 being given sedation pills that were not prescribed is unsubstantiated. It was alleged “Staff did not ensure resident was fed.” It was alleged that R1 was not fed solid food for (3) days straight and was only given Ensure. It was alleged R1 lost 50 to 60 pounds while at the facility due to malnourishment. Interview with R1 revealed all their care needs were being met by staff. Interview with (1) administrative staff revealed R1 was on Hospice services and refused to eat, but was being provided Ensure. Interview with (1) confidential witness revealed no concerns over the care R1 was receiving at the facility. No records for R1 were retained by the facility or available for review. Therefore, the allegation that staff was not ensuring R1 was being properly fed 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 provided.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 18-AS-20210610081401

Allegation investigated: 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.

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 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. (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.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 18-AS-20210422092430

Type of visit: Required - 1 Year

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.the state’s words, verbatim · CDSS document, Jan 3, 2025

Type of visit: Required - 1 Year

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.the state’s words, verbatim · CDSS document, Jan 12, 2024