Affinity Senior Living 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. LPA met with Analisa Cayabyab, Administrator, and informed them of the purpose of the visit. At the time of the visit, there were three (3) staff members and six (6) 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 in the backyard. 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 120°F. Fire extinguisher located at kitchen wall 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. Six (6) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed centrally stored medication record and confirmed all medication were listed. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 12-16-2025, 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 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Analisa Cayabyab, Administrator, and informed them of the purpose of the visit. At the time of the visit, there were 2 staff members and 7 residents present. Facility Overview: The facility is a one-story home with 6 bedrooms and 3 bathrooms, including an attached garage. There are no known firearms on the premises. There is a fenced swimming pool with locked gate in backyard which is in compliance with local regulations. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. 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 105°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. Continues 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 4 staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. 5 resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 12-12-2024, 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 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with, Administrator, Analisa Cayabyab, who was informed of the purpose of the visit. At time of visit there were (9) clients and (3) staff present. The facility is a one story home with (6) bedrooms and (3) bathrooms with attached garage. The facility does have a pool which has a locked gate surrounding it. No fire arms are kept at the facility. The facility is designated as a residential care facility for the elderly serving elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Infection Control: LPA observed the hand washing stations in the facility hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards and contained outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 115F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: LPA reviewed staff files and training that contained staff criminal clearance and CPR/First Aid. The annual training for (2) staff were not available for review during the time of the visit. Deficiency was cited and plan of correction was documented with staff. Technical advisory note was documented for staff to provide the written staff schedule to LPA. Resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in a cabinet. LPA reviewed client medications for residents and found all medication listed and all required labeling was found to be in place. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA was informed the last drill was conducted in April of 2023. Deficiency was cited for facility to conduct drills when required. Plan of correction was created with administrator. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where this report, deficiency page, and appeal rights were reviewed and provided to Administrator, Analisa Cayabyab.the state’s words, verbatim · CDSS document, Jan 12, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a case management visit on the health, safety, and welfare of residents in care. LPA met with the Caregiver, Gloria Antonio. LPA was informed that ten (10) residents currently reside at this facility, with a capacity of ten (10). There were two (2) staff on duty during the time of the visit. LPA toured the facility and observed all facility utilities to be on and operating without issues. There is no immediate concern for residents in care. 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 with Caregiver, Lilia Cayabyab and a copy of this report is left with the her as evidence by her signature.the state’s words, verbatim · CDSS document, Nov 15, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a case management visit on the health, safety, and welfare of residents in care. LPA met with the Caregiver, Gloria Antonio. LPA was informed that ten (10) residents currently reside at this facility, with a capacity of ten (10). There were two (2) staff on duty during the time of the visit. LPA toured the facility and observed all facility utilities to be on and operating without issues. There is no immediate concern for residents in care. 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 with Caregiver, Gloria Antonio and a copy of this report is left with the her as evidence by her signature.the state’s words, verbatim · CDSS document, Oct 10, 2023