The Pageantry Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry into the facility by Staff Jessie Santos. LPA met with Staff Katherine Espina and the purpose of the inspection was discussed. Administrator (AD) Macrina Jabonero was contacted by phone and arrived at approximately 9:30 a.m. During the inspection, LPA and Staff Espina conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a single-story house with six resident bedrooms, five bathrooms, two staff bedrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 109.2 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated November 18, 2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed four of four resident files and three staff files. LPA interviewed two residents and two staff. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 3, 2025

Allegation investigated: Resident was forced to take PRN medication Resident was physically abused by staff

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Administrator (AD) Macrina Jabonero and explained the purpose of the inspection. Regarding the allegation Resident was forced to take PRN medication, the following was revealed: It is alleged R1 is being forced to take PRN medication. During the course of the investigation, interviews were conducted with R1, two additional facility residents, and two staff. During their interview, R1 denied ever being forced to take to any medication, including PRNs. Per R1, staff provide their medication to them by placing it in a medication cup and handing it to them, they then independently take the medication orally. During their interview, Resident 2 (R2) was unable to confirm or deny the allegation, however, LPA did observe R2 was provided with their medication, which was placed in a medication cup by staff. LPA then observed R2 take medication orally and independently. During their interview, Resident 3 (R3) denied the allegation and stated they have never been forced to take their medication and denied witnessing staff forcing any other resident to take their medication. (Cont. LIC9099-C) Unsubstantiated During their interview, Staff 1 (S1) denied ever personally forcing R1 or any other resident to take their medication. S1 also denied witnessing or having any knowledge of any other staff forcing any resident to take their PRN medication or any other medication. During their interview, AD denied staff force R1 or any other resident to take their medication and stated R1 is able to take medication independently without staff intervention. Regarding the allegation Resident was physically abused by staff, the following was revealed: It is alleged staff physically hold R1’s hands or hit R1 if R1 does not comply with taking PRN medication. During their interview, R1 denied ever being physically abused by staff and denied staff hitting them or holding their hands in order to get them to take PRN medication. During their interview, Resident 2 (R2) was unable to confirm or deny the allegation. During their interview, Resident 3 (R3) denied being personally hit by any staff and denied witnessing or having any knowledge of staff physically abusing or hitting any other resident. During their interview, Staff 1 (S1) denied ever personally hitting R1 or any other resident and denied witnessing or having any knowledge of staff physically abusing or hitting any resident. During their interview, AD denied personally hitting R1 or any other resident. AD also denied witnessing or receiving any reports of staff physically abusing or hitting any resident. Due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Resident was forced to take PRN medication or if Resident was physically abused by staff. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 22-AS-20250902145332

Allegation investigated: Facility staff hit a resident on the head

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez for the purpose of delivering findings. LPA met with Administrator (AD) Macrina Jabonero and explained the purpose of the inspection. Complaint alleges former Staff 1 (S1) hit Resident 1 (R1) on the head. During the course of the investigation, interviews were conducted with R1, facility residents, and staff. During their interview, R1 did not disclose any physical abuse and stated facility staff treat him well. R1 denied ever witnessing or having any knowledge of staff hitting any resident and denied being personally hit by any staff. Interviews were also conducted with two additional facility residents; both denied being personally hit by staff or ever witnessing or having any knowledge of staff hitting any other resident. During their interview, AD stated an internal investigation into the allegation was conducted, consisting of resident and staff interviews, and did not reveal any wrongdoing by S1. (Cont. LIC9099-C) Unsubstantiated Per AD, a physical check of R1 was conducted and no bruising, discoloration, laceration, or injury was observed on R1’s head. AD stated that although the allegation was uncorroborated, the facility and S1 decided to amicably part ways, and S1 is no longer employed by the facility. LPA attempted to contact S1 by phone, however, S1 could not be reached to confirm or deny allegation. Due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if facility staff hit a resident on the head. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jun 25, 2025 · control 22-AS-20250620162005

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Licensee Edna Tamondong and Administrator Macrina Jabonero were notified by telephone and arrived later to assist with the visit. There are currently four residents in care, three of which are receiving hospice care. LPA observed residents relaxing in their respective bedrooms and in the facility's common living areas, as well as having lunch in the facility's dining room. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has six private bedrooms and one staff room. There are three en-suite bathrooms and one shared bathroom throughout the facility. Bedrooms appeared clean and sanitary. Three beds are observed to be equipped with full rails. The hospice plans of care for the respective residents were reviewed and verified to include an order for the postural supports. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathrooms are equipped with grab bars and slip mats. Hot water temperature measured at 108F, 115F and 118F in three separate bathrooms with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items are stored in the secure drawer along with cleaning supplies in the laundry area. Medication central storage is stored securely in a locked closet. Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The attached garage is inaccessible to residents. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating area with furniture for resident use. There are self-latching gates on each route of egress. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed four resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. Oxygen is in use and a sign was observed to be in place. There are no bedridden residents present on the premises. LPA reviewed staff records for six staff members. Records were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Mar 21, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.