Queen's Home I

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Ruth Martinez and Taylor Simerly arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by Caregiver and stated the reason for the visit. Administrators Arash and Arya Maghbouleh arrived on premise and remained at the facility to assist with the inspection. Administrator Arya has a valid administrator's certificate expiring on August 17, 2027, and August 15, 2027, for Arlene Mahinay. There are six (6) residents that reside at this facility and there is one (1) resident is receiving hospice services currently. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of five resident bedrooms and two resident bathrooms. LPAs began the tour of the inside and outside of the facility. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in two freezers located in the garage. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a safe locked storage cabinet located in the caregiver bedroom. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs observed the first aid kit and verified all required supplies were present. LPAs inspected the facility bathrooms and LPAs measured the hot water temperature which measured 114.2 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper Continued on LIC809-C and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink, laundry unit cabinets, and storage cabinet in the garage. The facility has an available clean supply of linens. LPAs inspected residents’ bedrooms which has sufficient lighting to ensure safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors/carbon monoxide detectors were tested and found to be operational. LPAs toured outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there are shaded seating areas for residents’ enjoyment in the backyard of the facility. LPAs observed a fire extinguisher with service date of April 28, 2026, charged and mounted in the kitchen and underneath the kitchen sink. Fire drills are conducted every three months, LPAs verified fire drill logs are kept and LPA verified drills are being conducted. LPAs began reviewing records. LPAs reviewed six resident records. All the required documentation was present and reviewed in the residents’ files. LPAs reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPAs observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrators, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Ronelex Dalut and stated the reason for the visit. Administrator (Admin) Arya Maghbouleh arrived on premise and remained at the facility to assist with the inspection. Admin Arya has a valid administrator's certificate expiring on August 17, 2027, August 17, 2027 for Arash Maghbouleh, and August 15, 2027 for Arlene Mahinay The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of five resident bedrooms and two resident bathrooms. Facility operates within the conditions and limitations specified on the license. LPA observed four residents in care of which two are receiving hospice services. LPA observed three caregivers on duty and verified fingerprint clearance and association statuses including the administrators. LPA toured the interior portion of the facility. All common areas were inspected which includes the laundry room and attached two car garage. The fireplace was screened. LPA inspected the five resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. The hot water temperature in both bathrooms measured at 112.8 and 111.3 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The two exit gates on each side of the property were operational, and there were sufficient seating and shading in the patio area. The two fire extinguishers were serviced on June 13, 2025 per review of the invoice. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency food/water and supplies in the closet and kitchen. The first aid kit had all necessary elements. Fire drills were conducted monthly. The required Complaint Poster (PUB475) poster was posted in the entry way in the correct size requirement. LPA reviewed four out of four resident files and three personnel files in which no discrepancies were found. Facility maintained all bed rail orders for the three residents. Medications were audited for two out of four residents and no discrepancies were found. The following was addressed during the visit: to ensure the emergency drills conducted account different emergency scenarios. Admins were advised to inform the Department prior to making any alterations and will provide a plan as discussed during the consult. Based on the observations made during today's visit, no deficiencies are being cited. An Advisory Note is being issued. An exit interview was conducted with Administrators Kathy Maghbouleh, Arya Maghbouleh, and Arash Maghbouleh, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Sep 23, 2025

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: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA Cho was greeted and granted entry by Administrator (Admin) Arya Maghbouleh and explained the reason for the visit. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory of which all may be bedridden and maintains a hospice waiver for six (6). There are three (3) residents under hospice and one (1) bedridden resident during today's visit. LPA toured the interior and exterior portions of the facility. There are a total of five resident bedrooms and two resident bathrooms. There are two staff bedrooms. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails, and a non-skid floor mat. The hot water temperature measured at 117.3 and 115.5 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supplies. LPA observed medications, toxins, and sharps were inaccessible to the residents. The three fire extinguishers were purchased on today's date. LPA observed clutter in the garage which is a safety hazard. For the exterior portion, facility had sufficient seating and shading. The exit doors were self-closing and self-latching. LPA observed the emergency disaster supplies including food/water. LPA observed the required "See Something, Say Something' (PUB475) poster in the required size. Administrator's Certificate for Kathy Maghbouleh expires on 12/06/24. LPA conducted an audit of six residents' files and two staff files. No discrepancies noted however please ensure that the health screening for the staff is completed by June 22, 2024. Staff and resident interviews were conducted. Medications were audited. No discrepancies noted. LPA consulted the following: to clear the clutter in the garage in order to adhere to the regulations by the State Fire Marshal, to obtain a medical assessment and Tuberculosis test results using the Physician's Reports (LIC602s), to ensure a medical assessment including the health screening is completed for an employee, to obtain doctor's orders for the full bed rails, and to conduct and maintain a log for the earthquake drills. Based on the observations made during today's visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See the attached LIC90999Ds. A Technical Violation is being issued today. See the attached LIC9102. An exit interview was conducted with Administrator Arya Maghbouleh, and a copy of this report including the LIC809C, LIC809Ds, LIC9102, LIC811s, and the appeal rights were provided during this visit.the state’s words, verbatim · CDSS document, Jun 18, 2024