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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005310
Report Date: 07/29/2026
Date Signed: 07/29/2026 10:44:03 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
04/02/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250402151104
FACILITY NAME:QUEEN'S HOME 2FACILITY NUMBER:
306005310
ADMINISTRATOR:MAGHBOULEH, KATAYOUNFACILITY TYPE:
740
ADDRESS:26545 AVENIDA DESEOTELEPHONE:
(949) 716-1907
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Arlene MahinayTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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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
INVESTIGATION FINDINGS:
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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
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
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 7
Control Number 22-AS-20250402151104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: QUEEN'S HOME 2
FACILITY NUMBER: 306005310
VISIT DATE: 07/29/2026
NARRATIVE
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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)
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20250402151104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: QUEEN'S HOME 2
FACILITY NUMBER: 306005310
VISIT DATE: 07/29/2026
NARRATIVE
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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)
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20250402151104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: QUEEN'S HOME 2
FACILITY NUMBER: 306005310
VISIT DATE: 07/29/2026
NARRATIVE
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 22-AS-20250402151104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: QUEEN'S HOME 2
FACILITY NUMBER: 306005310
VISIT DATE: 07/29/2026
NARRATIVE
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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)
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20250402151104
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: QUEEN'S HOME 2
FACILITY NUMBER: 306005310
VISIT DATE: 07/29/2026
NARRATIVE
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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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
04/02/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250402151104

FACILITY NAME:QUEEN'S HOME 2FACILITY NUMBER:
306005310
ADMINISTRATOR:MAGHBOULEH, KATAYOUNFACILITY TYPE:
740
ADDRESS:26545 AVENIDA DESEOTELEPHONE:
(949) 716-1907
CITY:MISSION VIEJOSTATE:CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Arlene MahinayTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Allegation 2: Facility did not inform family regarding care or services for resident
INVESTIGATION FINDINGS:
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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 relevant documents.

It was alleged the facility did not inform the family regarding Resident 1's (R1) care or services. LPA interviewed AD Maghbouleh and reviewed facility records, incident reports, hospital records, and correspondence regarding the allegation. AD Maghbouleh stated R1's family remained actively involved in
(Complaint Investigation Report continued on LIC9099C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7