Evonne's Residential Care Home #1

Allegation investigated: Staff handled residents in a rough manner Facility staff did not intervene in resident altercation. Facility staff do not accord residents with dignity and respect

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Philomena Agbontaen. On April 13, 2026, the Department received a complaint alleging staff handled residents in a rough manner On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed residents R2-R7. 6 Out 6 residents (R2-R7 ) stated they have never observed staff handling residents in a rough manner. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Philomena Agbontaen, referred to as S1 and staff S2. Both staff interviewed (S1 and S2) stated facility staff have never handled residents in a rough manner. Page 1 Out of 5. Unfounded On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she visits the facility frequently. W1 stated he/she has never observed staff handling residents in a rough manner. On May 6, 2026, Licensing Program Analyst Manuel Monter interviewed resident R1. R1 stated, facility staff were never rough with him/her. R1 stated he/she never saw the staff being rough when providing care to other residents. R1 stated he/she didn’t see any instance of the staff being rough when providing care. On May 6, 2026, Licensing Program Analyst Manuel Monter interviewed witness W2. W2 stated he/she didn’t observe any instance where staff where handling residents in a rough manner. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Facility staff did not intervene in resident altercation. On April 13, 2026, the Department received a complaint alleging Facility staff did not intervene in resident altercation. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed residents R2-R7. 6 Out 6 residents (R2-R7 ) stated they are not aware of any resident on resident altercations or incidents where residents throw objects at each other. Page 2 Out of 5. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Philomena Agbontaen, referred to as S1 and staff S2. S1 stated there hasn’t been any resident on resident altercations at the facility. S1 stated there was an incident on the last day R1 was at the home. S1 stated on April 3, 2026, around 10:30-11:00pm, she and S2 heard a sound and R1 began making a commotion. S1 stated when she and S2 entered the room, they asked R1 what had happened. R1 stated his/her phone fell. R1 stated he/she was upset with his/her family member. S1 stated resident R2, was laying in his/her bed asleep. S1 stated R1’s phone was on the ground, near the side of R1’s bed, near the foot area. S1 stated R2 does not have a cell phone. S1 stated when she did ask R1 what had happened, R1 started saying racial slurs, saying negative things regarding R2 race, skin color and also began saying racial things about her and S2. S2 stated on the last night R1 was at the home, around 10:30-11:00pm, he/she and the S1 heard a loud sound, or something falling. S2 stated he/she and the S1 then went to R1 and R2’s room. S2 stated as they approached, they could hear R1 making a commotion yelling. S2 stated they asked R1 what happened, and R1 stated he/she threw his/her “f-ing” phone. R1 stated he/she threw the phone because he/she can and told staff to pick it up. S1 stated the phone was on the ground close to R1’s right foot. S2 stated he/she observed that R2 was asleep, as he/she entered the bedroom. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she isn’t aware of any resident on resident altercations or instances where residents are throwing objects at each other. On May 6, 2026, Licensing Program Analyst Manuel Monter interviewed resident R1. R1 stated his/her cell phone had fallen off the bed. R1 stated the S1 came running to room. R1 stated he/she didn’t have any altercations with the other residents. R1 stated he/she didn’t throw his/her phone at another resident. R1 stated no resident threw their phone at him. R1 stated the issue was when he/she dropped his/her phone by accident, it fell and made a loud sound. R1 stated the staff misunderstood. Page 3 Out of 5 The Department reviewed R1’s Progress notes dated April 3, 2026. The progress note stated, R1 threw phone across bedroom. S1 came in urgently due to noise. R1 was asked what that sound was since R1 was the only one awake. R1 replied, “ I threw my fucking phone. Go fucking pick it up.” S1 picked up the phone and asked why R1 threw it. R1 responded, “because I can, you work for me. I tell you what to do.” The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Facility staff do not accord residents with dignity and respect On April 13, 2026, the Department received a complaint alleging Facility staff do not accord residents with dignity and respect On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed residents R2-R7. 6 Out 6 residents (R2-R7 ) stated the facility staff treat them with respect. 6 Out 6 residents (R2-R7 ) stated they have never observed the staff treat residents in a disrespectful manner. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Philomena Agbontaen, referred to as S1 and staff S2. Both staff interviewed (S1 and S2) stated facility staff accorded all residents with dignity and respect. Both staff (S1 and S2) stated they have never observed staff not accord residents with dignity and respect. On April 21, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she visits the facility frequently. W1 stated he/she has never observed the staff treat residents in a disrespectful manner. Page 4 Out of 5. On May 6, 2026, Licensing Program Analyst Manuel Monter interviewed resident R1. R1 stated R1 stated he/she felt disrespected because the staff were not interacting with him/her. R1 stated the staff treated his/her roommate with kindness and attentiveness. R1 stated when his/her phone fell, staff came running in and asking R2 how he/she was. R1 stated staff didn’t look his/her way. LPA attempted multiple times for R1 to explain how the facility staff didn’t treat him/her with dignity or respect. R1 wasn’t answering the question and digressing to how he/she didn’t like his roommate and didn’t believe the S1 was a nurse. On May 6, 2026, Licensing Program Analyst Manuel Monter interviewed witness W2. W2 stated, when he/she went out to the facility, and saw the residents he/she didn’t see any issues. W2 stated he/she didn’t observe any instance of staff treating residents in a disrespectful manner or with a lack of dignity. The Department reviewed R1’s Progress notes dated April 3, 2026. The progress note stated, R1 threw phone across bedroom. S1 came in urgently due to noise. R1 was asked what that sound was since R1 was the only one awake. R1 replied, “ I threw my fucking phone. Go fucking pick it up.” S1 picked up the phone and asked why R1 threw it. R1 responded, “because I can, you work for me. I tell you what to do.” The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 5 Out of 5. End of Report.the state’s words, verbatim · CDSS document, May 7, 2026 · control 26-AS-20260413162742

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Philomena Agbontaen. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. while touring the facility kitchen with ADM, LPA observed there was no staff or residents in kitchen. LPA observed an unsecured half orange tablet on the kitchen table. S1 stated the half tablet belonged to resident R4. S1 stated there is a hold parameters for medication M1, based on the blood pressure. ADM stated R4's blood pressure was too low and the medication was on hold. S1 stated he/she had forgotten to put the medication tablet back. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 112 degrees F in resident bathrooms. Fire extinguisher was serviced in May 12, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 23, 2025. LPA reviewed 3 staff records. LPA reviewed facility records for 3 residents. LPA observed 3 Out of 3 resident (R1-R3) Needs and services plans were not updated. ADM stated she has not had the chance to update them. LPA reviewed 3 resident medications and centrally stored medication records. R3 had 4 medications bubble packs that were not listed. Furthermore, R3's had a medication bubble pack start date that was incorrect. R1 had two medications that were not listed on the centrally stored medication record. R2 had 1 medication not listed on the centrally stored medication record. A deficiencies are being cited during today's visit, see LIC809-D. This report was reviewed with Administrator Philomena Agbontaen and a copy of the signed report was provided. Appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) conducted an unannounced case management - other visit and met with Administrator (ADM) PHILOMENA AGBONTAEN. LPA observed 4 residents in the facility and 3 residents went to day program. LPA toured the facility inside and out with ADM. 5 resident rooms, 1 staff live-in room, 2 restrooms, living room, family room, kitchen and garage were inspected. LPA interviewed 4 residents )R1, R2, R3, R4). 4 out of 4 residents stated they like to live in the facility. 4 out of 4 residents stated the facility does not have change recently, and the facility operates as usual. 4 out of 4 residents stated they do not have any complaint. LPA interviewed ADM. ADM stated the facility operates normally as before. ADM stated he/she is waiting for the underwriter to document to the bank. ADM stated he/she will conform with LPA for the formal purchase closure date of the house. LPA toured the backyard, 1 storage room was observed at the backyard. No obstruction was observed to block the walkway. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Sep 12, 2025

Type of visit: Office

Licensing Program Analyst (LPA) and Licensing Program Manager (LPM) Romeo Manzano met with Licensee (LCN) Philomena Agbontaen and Administrator (ADM/daughter of LCN) Evonne Evien, who came to office requested a meeting with LPA and LPM. During the meeting, ADM has left the meeting due to work. During the meeting, LCN and ADM stated the property landlord is retiring and selling the property and has offered the opportunity for the LCN and her daughter/ADM to purchase the property. LCN stated that they applied for a business loan with her ADM/daughter. LCN inquired if her daughter/ADM can be added into the RCFE license for business loan purposes and/or requirements. Facility license is sole proprietorship to LCN Philomena Agbontaen. LCN stated the close date of the loan is 08/20/2025. LCN stated that if they do not meet the bank's requirements then the landlord's option is to put property on the market. LPA provided Centralized Application Bureau to contact on the procedure about adding a new licensee. LCN will submit a copy of their lease agreement. LCN stated that their lease agreement supposed to end approximately 3 years from now. The facility currently have 7 residents and LCN has been advised to inform residents and their family members regarding the sell of property and their plans, and also, to notify their designated LTCO - Ombudsman. Exit interview was conducted with LCN. This report was provided to LCN. No deficiency cited during today's visit.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Evonne Evien, Designated Administrator. LPA announced the purpose of the visit. LPA observed 6 resident and 2 staff. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature was measured at 43 degrees F and freezer temperature measured at 1 degrees F. LPA toured 6 residents bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 111-113 degrees F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 03/13/2023. LPA reviewed Fire and Earthquake log last disaster drill was conducted on 11/12/2024. ADM tested the smoke detectors in the hallway and found the smoke detector to function properly when tested. LPA reviewed 3 resident records and 3 staff records. LPA observed 3 staff records to be incomplete missing required documents. ADM reviewed 3 resident Centrally Stored Medication. Deficiency was cited as per California Code of Regulations Title 22. This report was reviewed with Designated Administrator Evonne Evien and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 14, 2025

Type of visit: Collateral

On 12/4/24 LPA's David Marrufo and Santino Fortes conducted an unannounced facility visit and met with Philomena Agbontaen to conduct a collateral visit to deliver a complaint for Evonne's Residential Care Home #3. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Philomena Agbontaen and a copy of this report was providedthe state’s words, verbatim · CDSS document, Dec 4, 2024

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced Case Management visit, to verify the change of capacity. LPA met with Administrator Philomena Agbontaen and explained the purpose of the visit. On April 24, 2024, Licensing Program Analyst Manuel Monter conducted a CM inspection to verify the change of capacity from 6 to 7 Non Ambulatory. According to Licensee/ADM, the facility did not have major construction; however they have an additional room herein they can convert to a resident's room. Fire clearance was granted on June 15, 2023, for an additional capacity in bedroom #6. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Apr 24, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Philomena Agbontaen. During the visit, LPA observed 7 residents and 2 staff. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 110 degrees F in both resident bathrooms. Fire extinguisher was serviced in March 13, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 2, 2023. LPA reviewed facility records for 3 staff. LPA reviewed facility records for 3 residents. LPA reviewed R1's facility file. R1's physicians report states R1 has dementia. R1's most current physicians report is dated September 6, 2022. ADM stated the physicians report has not been updated. LPA requested to review residents weight record log. ADM stated she doesn't have a log for the residents weights. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). Deficiencies are being cited during today's visit. This report was reviewed with Administrator Philomena Agbontaen and a copy of the signed report was provided. Appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 14, 2024