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August 29, 2025 Mohamed Ali, Authorized Agent Shifo Adult Center Inc 373 Pedersen Street Suite 101B License Number: 1091375 (Rule 223) CORRECTION ORDER Dear Mohamed Ali: On June 23, 2025, a licensing review of Shifo Adult Center Inc located at 373 Pedersen Street, Saint Paul, Minnesota was conducted to determine compliance with Minnesota Statutes and Rules governing adult day care services under Minnesota Rules, parts 9555.9600 through 9555.9730 (Rule 223). As a result of this licensing review, a Correction Order is being issued. A. Reason for Correction Order Pursuant to Minnesota Statutes, section 245A.06, if the Commissioner of the Department of Human Services (DHS) finds that the license holder has failed to comply with an applicable law or rule and this failure does not imminently endanger the health, safety, or rights of the persons served by the program, the Commissioner may issue a Correction Order to the license holder. The following violation(s) of state or federal laws and rules were determined as a result of the licensing review. Corrective action for each violation is required by Minnesota Statutes, section 245A.06 and is hereby ordered by the Commissioner of Human Services. 1. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3.
The license holder did not review P2’s and P3’s IAPP quarterly as part of the review of P2’s and P3’s program plan or service plan. The license holder maintained documentation that P2’s and P3’s IAPP was most recently reviewed in January 2025.
2. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For two of two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain a personnel record as required. The license holder did not maintain a job description in SP1 and SP2’s personnel records. Repeat Violation: In an Order of License Revocation that DHS issued on March 17, 2025, you were previously found in violation of this same rule. 3. Citation: Minnesota Rules, part 9555.9690, subpart 3. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation to the center as required. The license holder did not provide SP1 and SP2 with 20 hours of orientation to the center within the employee’s first 40 hours of employment at the center. The license holder maintained documentation that SP1 received 11 hours of training and SP2 received 13 hours of training within their first 40 hours of employment at the center. Repeat Violation: In an Order of License Revocation that DHS issued on March 17, 2025, you were previously found in violation of this same rule. 4. Citation: Minnesota Rules, part 9555.9710, subparts 1 and 7. Violation: The license holder did not offer services as required. a. The license holder did not ensure the menus for all meals and snacks were approved by a registered dietician. b. The license holder did not maintain a copy of the menu for all meals served for at least six months. c. The license holder did not maintain a family and social history in P1, P2 and P3’s participant records that was updated annually. Repeat Violation: In an Order of License Revocation that DHS issued on March 17, 2025, you were previously found in violation of this same rule. 5. Citation: Minnesota Rules, part 9555.9720, subpart 9. Violation: The license holder did not ensure safety as required. The license holder did not ensure the emergency plans were posted in a visible place within the center. Corrective Action Ordered: Immediately, you must post a copy of the emergency plans in a visible place within the center. On an ongoing basis, you must maintain compliance as required in this subpart. B. Right to Request Reconsideration If you believe any of the citations are in error, you have the right to request that the Commissioner of Human Services reconsider the parts of the Correction Order that you believe to be in error. The request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this report. Your request for reconsideration must be sent to: Commissioner, Department of Human Services Please note that a request for reconsideration does not stay any provisions or requirements of the Correction Order. The Commissioner’s disposition of a request for reconsideration is final and not subject to appeal under Minnesota Statutes, chapter 14. If you have any questions regarding this Correction Order, please contact me as soon as possible. Alexandra Devick, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4626
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