Facility Evaluation Report

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced case management visit to follow up on an incident report received by Community Care Licensing on 11/17/2025. LPA met with Gerald Hester, DSP and discussed the purpose of the visit. Administrator Ethel Gray arrived during the visit.

On 11/17/2025, LPA received a self- reported death report from the facility regarding a client passing away. Client 1 (C1) was admitted to a Care Facility on 9/14/2025 due to their diagnosis of Stage 4 kidney disease/ renal failure. C1 was then was admitted to the hospital on 10/30/2025 due to their organs shutting down and receiving comfort care. C1 passed away on 11/04/2025 in the hospital.

Per staff, C1s cause of death is unknown at this time. There isn't a death certificate as of today's date.

During today's visit, LPA Holmes briefly toured the facility, conducted interviews with facility staff and reviewed client records. A review of records revealed that C1

No deficiencies were issued during today's visit. An exit interview was conducted with Gerald Hester, DSP, to whom a copy of this report, Confidential Names (LIC 811) and the Licensee's/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.