Facility Evaluation Report

Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit. LPA identified herself and was granted entry by Caregiver Teyba Abdu. LPA met with Abdiaziz Hussen, Manager

On October 21, 2022, the facility self reported a resident death regarding Resident 1 (R1) (See LIC 811 Confidential Names List) to Community Care Licensing. This visit was conducted to follow-up with the death report.

During today’s visit, LPA briefly toured the facility, conducted an interview with Abdiaziz Hussen, Manager, requested and obtained relevant records. This case management visit requires further follow-up and a copy of the resident's death certificate was requested upon receipt. No deficiencies were cited during today’s visit.

An exit interview was conducted with Abdiaziz Hussen, Manager, and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the Manager at the conclusion of the visit.