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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006054
Report Date: 06/25/2025
Date Signed: 06/25/2025 10:51:18 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2025 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250620162005
FACILITY NAME:PAGEANTRY COTTAGE, THEFACILITY NUMBER:
306006054
ADMINISTRATOR:JABONERO, MACRINAFACILITY TYPE:
740
ADDRESS:125 PAGEANTRY DRTELEPHONE:
(714) 504-5371
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 6DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Macrina JaboneroTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Facility staff hit a resident on the head
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20250620162005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PAGEANTRY COTTAGE, THE
FACILITY NUMBER: 306006054
VISIT DATE: 06/25/2025
NARRATIVE
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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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2