Queen's Home 2

Allegation investigated: Allegation 1: Facility refused to allow resident back without payment Allegation 3: Facility administrator was yelling in the facility Allegation 4: Facility neglected to report pressure injury Allegation 5: The facility does not maintain room temperature to sixty eight degrees Allegation 6: Facility does not provide food of good quality

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the purpose of the visit. Licensee (LE) Kathy Maghbouleh and Administrator (AD) Arya Maghbouleh were unavailable during today's visit. However, the Licensing Program Analyst (LPA) spoke with management staff by telephone. The Department received a complaint on April 2, 2025. During the investigation, LPA Tea conducted interviews and reviewed facility records, emails, admission documents, hospital records, home health records, and other documents. It was alleged that the facility refused to allow Resident 1 (R1) to return without payment. During the investigation, LPA interviewed AD Maghbouleh, who denied refusing R1's return to the facility. AD Maghbouleh stated that while R1 was temporarily admitted to a skilled nursing facility (SNF), the Assisted (Complaint Investigation Report continued on LIC9099C) Unsubstantiated Living Waiver (ALW) Program no longer reimbursed the facility for room and board. AD Maghbouleh explained that if the family wished to continue reserving R1's room, they would have been responsible for paying privately in accordance with the Admission Agreement. AD Maghbouleh further stated the facility never initiated an eviction and held the room while discussing the matter with the family. LPA reviewed email correspondence between the facility and Community Care Licensing, which showed the facility was advised that R1 retained the right to the room until the family voluntarily vacated the facility or the facility completed the eviction process in accordance with Title 22 regulations. LPA also reviewed an email dated March 1, 2025, from R1's family stating that R1 would not be returning to Queen's Home 2 following discharge from the SNF and that they would retrieve R1's personal belongings. The facility documented that the family removed R1's belongings and chose another placement for R1. Based on interviews and records reviewed, the evidence did not show that the facility refused to allow R1 to return. Although the family would have been responsible for paying privately to hold R1's room while R1 remained at the SNF, the records showed the family chose another placement before any eviction action was taken. It was alleged that the facility administrator was yelling in the facility. LPA interviewed LE Maghbouleh and AD Maghbouleh, who both denied yelling at residents or family members. AD Maghbouleh acknowledged that discussions with the family occasionally became tense due to disagreements regarding R1's care and medical treatment but stated conversations remained professional. LPA interviewed facility staff, residents, and other pertinent witnesses. Interviews did not corroborate that the Administrator or Licensee yelled at residents or visitors. Interviews provided different accounts of the conversations between the facility administrators and the family. It was alleged that the facility does not maintain room temperature to sixty-eight degrees. LPA interviewed the Licensee, Administrator, staff, and residents regarding the allegation. The Licensee and Administrator stated the home's heating and air conditioning systems were operational and routinely maintained. Staff denied any concerns regarding indoor temperatures. (Complaint Investigation Report continued on LIC9099C) During the investigation, LPA toured the facility and observed no conditions indicating excessively hot or cold indoor temperatures. At the time of the visit, the indoor temperature throughout the facility ranged between 68 and 78 F degrees, which is within a safe and comfortable range. Residents interviewed stated the home was comfortable and did not report concerns regarding room temperature. LPA did not observe or obtain documentation showing the facility failed to maintain a safe and comfortable indoor temperature. It was alleged that the facility does not provide food of good quality. LPA interviewed the Licensee, Administrator, staff, and residents and toured the kitchen and food storage areas regarding the allegation. The Administrator stated residents receive three nutritious meals each day with snacks available between meals. Staff stated meals are prepared daily and modified when needed to meet physician-ordered dietary requirements. During the facility tour, LPA observed an adequate supply of fresh produce, meat, dairy products, and pantry items. Food was properly stored, and the kitchen and food preparation areas were clean and sanitary. Residents interviewed stated they enjoyed the meals served and did not express concerns regarding the quality or quantity of food provided. It was alleged that the facility neglected to report a pressure injury. LPA reviewed Hospital records, which showed R1 was admitted on January 13, 2025. During the hospitalization, hospital staff identified a pressure injury to R1's right heel. The hospital records documented the pressure ulcer as present upon admission and later described the wound as unstageable. The hospital records included documentation that the wound was present upon admission and referenced information reported by R1's family member regarding a prior ulcer. However, the hospital records did not determine when the pressure injury developed, identify its cause, conclude that Queen's Home 2 caused the injury. The records further did not document that the facility had been notified of the pressure injury before or during R1's hospitalization. The discharge records included orders for continued skilled nursing and wound care after R1 left the hospital. LPA reviewed Home Health (HH) records for R1, which showed HH provided skilled nursing services before R1's hospitalization and a second HH agency provided services after hospitalization. The records did not document a pressure injury before R1 was hospitalized and showed HH’s services transferred to another home health agency after being hospitalized. (Complaint Investigation Report continued on LIC9099C) During the investigation, LPA interviewed an HH case manager, who stated they primarily provided behavioral health support, medication management, and coordination of care while R1 resided at Queen's Home 2. The case manager stated they did not observe neglect by facility staff and believed the facility appropriately cared for R1. LPA reviewed HH records for the second HH agency, which showed they began providing skilled nursing and wound care after R1 was discharged from the Hospital. The records documented wound assessments, dressing changes, wound measurements, pressure-relieving interventions, caregiver education regarding repositioning and skin integrity, and ongoing monitoring of the pressure injury. However, the records did not establish when the pressure injury developed or identify Queen's Home 2 as the source of the wound. LPA interviewed a representative from the second HH, who confirmed they provided wound care, skilled nursing, and safety services for R1 after hospital discharge. The representative stated the wound was identified as unstageable but could not confirm whether their HH notified Queen's Home 2 that R1 had a pressure injury. LPA made multiple attempts by telephone and email to contact the assigned case manager and other clinical case managers but was unsuccessful. As a result, LPA was unable to verify whether they informed the facility of the pressure injury before or during the provision of wound care services. LPA interviewed three facility staff members, who consistently stated they were unaware that R1 had developed a reportable pressure injury while residing at the facility. Staff stated they routinely communicated with home health providers regarding residents' medical conditions and regularly asked visiting clinicians for updates on any changes in wounds or skin condition. Staff consistently stated that if they had been informed R1 had developed a reportable pressure injury, they would have immediately notified management so the incident could be documented and reported to Community Care Licensing. LPA interviewed AD Maghbouleh and LE Maghbouleh, who stated the facility was never informed by either HH agencies that R1 had developed a pressure injury while residing at Queen's Home 2. They stated the facility first became aware of the pressure injury after R1 was hospitalized. Although medical records confirmed that R1 had a heel pressure injury and later received wound care through Home Health, the investigation did not establish when the pressure injury developed, whether it (Complaint Investigation Report continued on LIC9099C) developed while R1 was residing at Queen's Home 2, or that the facility knew R1 had a reportable pressure injury and failed to report it. Based on interviews and records reviewed, LPA did not obtain sufficient evidence to determine that the facility neglected to report R1's pressure injury. Based on interviews conducted and records reviewed during the investigation, LPA did not obtain sufficient evidence to support the above allegations. Therefore, the above allegations are determined to be UNSUBSTANTIATED, meaning that although the allegations may have occurred or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred. No deficiencies are cited at this time. An exit interview was conducted with House Manager Arlene Mahinay in person and with Administrator Arya Maghbouleh by telephone. A copy of this report and the Confidential Names List were provided to the facility. R1's care throughout R1's residency and was routinely informed of R1's condition, physician recommendations, medication changes, behavioral concerns, and services provided by the facility. LPA also interviewed R1's treating physician, who stated they regularly communicated with R1's family regarding R1's medical condition, treatment recommendations, and overall care. The physician stated the family was actively involved in discussions regarding R1's care but frequently disagreed with recommended treatment plans and often preferred alternative or holistic approaches instead of prescribed medical treatment. The physician stated these disagreements did not prevent communication with the family regarding R1's care. Facility records showed the family was contacted whenever R1 experienced a medical emergency requiring hospitalization. Documentation also showed the family participated in care decisions and regularly communicated with the facility regarding R1's treatment. Hospital records identified R1's family as emergency contacts and responsible parties and reflected ongoing communication among the facility, R1's physician, home health providers, and the family. Therefore, the above allegation has been determined to be UNFOUNDED, meaning the allegation is deemed false, could not have happened, and/or are without a reasonable basis. No deficiencies are cited at this time. An exit interview was conducted with House Manager Arlene Mahinay in person and with Administrator Arya Maghbouleh by telephone. A copy of this report and the Confidential Names List were provided to the facility.the state’s words, verbatim · CDSS document, Jul 29, 2026 · control 22-AS-20250402151104

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents of which all six may be bedridden. Facility has an approved hospice waiver for six residents and the home currently has six residents, with three residents on hospice. Administrators (ADs) Arlene Mahinay, Arya Maghbouleh, and Arash Maghbouleh arrived shortly to assist with inspection. LPA along with staff toured the facility at 9:09 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, staff room, living room, dining room, kitchen, six bathrooms and an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 116.6 degrees F and 119.8 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet below the sink during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans. Facility conducts monthly emergency drills with the last drill conducted on 6/7/2026. Outside grounds were toured. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed six resident files and two staff files. All resident files contained documentation including admission agreements, physician reports, and resident appraisals. One resident file did not include evidence of physician's orders for half bed rails. Staff files reviewed contained documentation including, medical assessment, criminal record clearance and proof of CPR training. Staff files reviewed did not include evidence of TB testing. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Jun 23, 2026

The state marks this report as 11 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On September 24, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator Arlene Mahinay was available to assist with the facility inspection. Administrator Arya Maghbouleh arrived shortly after to assist with inspection. The facility is licensed for six (6) non-ambulatory residents which all may be bed ridden, with approved hospice waiver for six (6) residents. Currently, there are three (3) Hospice residents present during today’s visit. This is a single story with attached garage facility. The facility has seven bedrooms, (6 private resident rooms, 1 staff room) and six bathrooms. LPA conducted a tour of the physical plant accompanied by Administrator Mahinay, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 116.2 to 120 degrees F. A comfortable temperature of 76 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has three fire extinguishers that were fully charged. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The last fire drill was conducted on 9/2/25. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 1/9/2025 – 1/9/2026. The facility is current on Community Care Licensing annual dues. A review of six residents (R1-R6) service files revealed to be complete. The facility has the current administrator's certification on file for Arlene Mahinay - Expiration 08/15/2027. No deficiencies during this inspection visit. An exit interview was conducted with Administrator , and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2025

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) Arlene Mahinay and Caregiver Mario Mahinay. Admin Arya Maghbouleh arrived at the facility to assist with the inspection. 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 is one (1) resident under hospice care during today's visit. LPA toured the interior and exterior portions of the facility. There are a total of six resident bedrooms and six resident bathrooms. There is also one staff bedroom and a private staff bathroom. 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. A camera observed in the bedroom of Resident # 5 (R5) was removed during the visit. 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 116.6, 115.3, 118.2, 120.0, 120.0, and 118.9 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 four fire extinguishers were purchased on today's date. 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 located in the garage. LPA observed the required "See Something, Say Something' (PUB475) poster in the required size. Administrators' Certificates for Kathy Maghbouleh expires on 12/06/24. Administrator Arlene Mahinay whose certificate expired on 08/15/23 provided proof of completed course work during the visit. LPA conducted an audit of six residents' files and two staff files. Discrepancies noted in the staff file as the records were not available for review. Staff and resident interviews were conducted. Medications were audited for six residents. No discrepancies noted. LPA consulted the following: to ensure R5 is afforded privacy in their personal bedroom, to obtain a doctor's order for the full rail for one resident, to obtain a Tuberculosis Test (TB) result for one resident, and to ensure personnel records are maintained for each employee. 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. An exit interview was conducted with Administrators Arya Maghbouleh and Arlene Mahinay, and a copy of this report including the LIC809C, LIC809Ds, LIC811s, and the appeal rights were provided during this visit.the state’s words, verbatim · CDSS document, Jun 18, 2024