Mimi's Guest Home

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 09/25/2025 LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Criminal Record Transfer has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87307(e)(1)(A) pertaining to Personal Accommodations and Services has been cleared. LPA observed protective devices on the cook top knobs. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee provided proof of correction. Licensee addressed all items noted on the advisory note given 09/25/2025. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Mimi's Guest Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 5 non-ambulatory residents of which 1 may be bedridden. Facility has an approved hospice waiver for 4 residents and the home currently has 2 residents on hospice. Administrator Mimi Romero has an administrator certificate valid until 07/31/2027. LPA Lyman along with Administrator Mimi Romero toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The home consists of four resident bedrooms, 1 common restroom, 1 resident restroom, one staff room, living room, dining room, and kitchen. 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 106.8 and 115.7 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Auditory exit alarms were operational during today's visit. First aid kit had all the elements including thermometer, tweezers and scissors. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. LPA observed a fenced and secured pool. Exit gate is unlocked and operational. LPA observed ample emergency water supply. LPA reviewed the emergency disaster plan during the visit. CONT ON LIC809-C DATED 09/25/2025 Facility provided documentation of last fire drill conducted on 07/26/2025. Facility provides activities in the form of exercise, painting and music. LPA reviewed three resident files and two staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. . Resident 3 does not have a physician order for half bed rails in the file. Staff files reviewed contained required documentation as well as CPR training, criminal record clearance and required annual training. Staff 1 does not have association to the facility. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today's visit, deficiencies are being cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of the appeal rights were given at time of visit.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8:30am. During today’s visit, LPA met with Mimi Romero, Licensee (LE). The facility is a single story building with an approved fire clearance of five non-ambulatory residents of which one may be bedridden and approved for a hospice waiver for four. The facility currently has a census of three residents in care with one on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 105.6 and 119.8 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on August 9,2023. Licensee has an appointment for fire inspection to service fire extinguishers. The facility’s last fire drill was conducted on July 10, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA reviewed three of three staff training and fingerprint records. Staff require current First Aid/ CPR which Licensee will schedule. LPA conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on August 1, 2025. (See LIC 809-C) (Continuation from LIC 809) The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Mimi Romero and a copy of this report was given to the facility along with a copy of the LIC 9102-TV, LIC 858, LIC 859; LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 26, 2024

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.