STATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING JENNIFER M. GRANHOLM GOVERNOR ISMAEL AHMED DIRECTOR October 25, 2007 Ms. Diane Smith Diane's Inc 8445 Moorish Road Birch Run, MI 48415 RE: License #: Investigation #: AM730079322 2008A0871001 Diane s AFC Dear Ms. Smith: Attached is the Special Investigation Report for the above referenced facility. Due to the violations identified in the report, a written corrective action plan is required. The corrective action plan is due 15 days from the date of this letter and must include the following: How compliance with each rule will be achieved. Who is directly responsible for implementing the corrective action for each violation. Specific time frames for each violation as to when the correction will be completed or implemented. How continuing compliance will be maintained once compliance is achieved. The signature of the responsible party and a date. If you desire technical assistance in addressing these issues, please feel free to contact me. In any event, the corrective action plan is due within 15 days. Failure to submit an acceptable corrective action plan will result in disciplinary action. If you desire technical assistance in addressing these issues, please feel free to contact me. In any event, the corrective action plan is due within 15 days. P.O. BOX 30650 LANSING, MICHIGAN 48909-8150 www.michigan.gov (517) 335-6124
Please review the enclosed documentation for accuracy and feel free to contact me with any questions. In the event that I am not available and you need to speak to someone immediately, please feel free to contact the local office at (989) 758-1754. Sincerely, Kathryn A. Huber, Licensing Consultant Bureau of Children and Adult Licensing 411 Genesee P.O. Box 5070 Saginaw, MI 48605 (989) 758-1922 enclosure
MICHIGAN DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING SPECIAL INVESTIGATION REPORT I. IDENTIFYING INFORMATION License #: Investigation #: AM730079322 2008A0871001 Complaint Receipt Date: 10/09/2007 Investigation Initiation Date: 10/09/2007 Report Due Date: 12/08/2007 Licensee Name: Licensee Address: Diane's Inc 8445 Moorish Road Birch Run, MI 48415 Licensee Telephone #: (989) 777-8183 Administrator: Licensee Designee: Name of Facility: Facility Address: Diane Smith, Designee Diane Smith, Designee Diane s AFC 8445 Moorish Road Birch Run, MI 48415 Facility Telephone #: (989) 777-8183 Original Issuance Date: 07/01/1999 License Status: REGULAR Effective Date: 02/06/2006 Expiration Date: 02/05/2008 Capacity: 12 Program Type: DEVELOPMENTALLY DISABLED MENTALLY ILL AGED 1
II. ALLEGATION(S) A staff member had her family at the facility on 10/07/07. The staff member was tired from having them visit and didn t pass out the meds that evening because she fell asleep. The staff member s mother told the residents to stay out of the kitchen. The staff member s mother is allegedly stealing food from the kitchen. III. METHODOLOGY 10/09/2007 Special Investigation Intake 2008A0871001 10/09/2007 Special Investigation Initiated - On Site Contact at residence; interviewed Staff 1, Residents A through G 10/15/2007 Contact - Telephone call received Telephone call from resident. 10/15/2007 Contact - Telephone call made Phone call to Administrator Austin Smith 10/17/2007 Contact - Face to Face Spoke with Home Manager and Resident F. 10/19/2007 Exit Conference Phone call to LD Diane Smith 10/19/2007 Inspection Completed-BFS Sub. Compliance 10/19/2007 Corrective Action Plan Requested and Due on 11/05/2007 ALLEGATION: The staff member did not pass out meds on 10/07/07 because she fell asleep. INVESTIGATION: This investigation was initiated on 10/09/07 with an unannounced onsite inspection. Staff 1 was present as well as seven residents. Staff 1 reported that the residents did get their medications on Sunday but she just didn t fill in the medication logs. Staff 1 2
said that she was working on the med sheets when I arrived at the facility. Staff 1 reported that there are currently nine residents living there but one is in the hospital. On 10/09/07, Residents A through G were all interviewed privately. Resident A reported he gets his meds okay and he has no complaints. Resident A couldn t remember if he got his meds on Sunday (10/07/07). Resident B said he always gets his meds and he gets too much meds. Resident C and D both said they get their meds every day. Resident E doesn t know if the residents got their medications on Sunday 10/07/07 because she is not on any medications. Resident F said that on Sunday (10/07/07), Staff 1 was too tired and did not give her medications. On 10/09/07, Staff 1 gave this, consultant copies of the resident medication log sheets. Six resident medication records were available. Residents C, D, and G s medication logs were completed fully and it was noted that the medications were initialed for 10/09/07 for the morning. Resident B s medication administration record indicated that seven medications were not recorded from 10/05/07 through 10/09/07. Resident F missed three medications from 10/05/07 through 10/09/07. Resident H s medication administration record indicated that nine medications were not recorded on the medication record. This consultant reviewed the medication packets. The medications dated October 5 th through the 9 th were not in their perspective bubble packs and it is unknown if these medications were administered. APPLICABLE RULE R 400.14312 Resident medications. ANALYSIS: CONCLUSION: (2) Medication shall be given, taken, or applied pursuant to label instructions. Resident F reported that she did not receive her medications on 10/07/07. The medication records indicated that Resident B and H did not receive their medications. The medication logs sheets indicate that Resident B, F, and H did not receive their medications. VIOLATION ESTABLISHED APPLICABLE RULE R 400.14312 Resident medications. (4) When a licensee, administrator, or direct care staff member supervises the taking of medication by a resident, he or she shall comply with all of the following provisions: (b) Complete an individual medication log that contains all of 3
the following information: (i) The medication. (ii) The dosage. (iii) Label instructions for use. (iv) Time to be administered. (v) The initials of the person who administers the medication, which shall be entered at the time the medication is given. ANALYSIS: CONCLUSION: This consultant made contact at the facility on 10/09/07. Three of the six resident medication logs were not completed for 10/06/07, 10/07/07 and 10/08/07. Staff 1 said that she did give all of the medications to the residents but did not complete the medication logs and that she was working on them when this consultant arrived at the facility. VIOLATION ESTABLISHED ALLEGATION: Residents are not afforded privacy when Staff 1 has family members visit at the facility. INVESTIGATION: On 10/09/07, Staff 1 stated that she lives in the facility. Staff 1 said that her mother, sister, niece and nephew visited her on Sunday. Staff 1 reported that her family arrived at the facility at approximately 1:00 p.m. and left at approximately 5:30 p.m. Staff 1 reported that her nephew is very active. On 10/09/07, Resident A said that sometimes, there are a lot of kids there but it doesn t bother him. Resident B said that the kids do not get on his nerves. Resident C said that she doesn t care that Staff 1 s family comes over. Resident D had no complaints. Resident E was then interviewed. Resident E reported that on Sunday (10/06/07), Staff 1 s mother, sister, niece and nephew come to the facility. Resident E said that Staff 1 s nephew runs up and down the hall and bangs on her door and this makes her nervous. Resident E said that she stays in her room because she doesn t like it when Staff 1 s family is there. Resident E also said that Staff 1 s mother told her get out of my kitchen and wait till I go home. Resident E thinks that Staff 1 s mother may be stealing food because she tells them to get out of the kitchen. Resident E has never seen her take food out of the facility. Resident F was then interviewed on 10/09/07. Resident F reported that no one gets meds or dinner when Staff 1 s 4
family is there. Resident F said they do get meds when her Staff 1 s family is not there. On 10/19/2007, phone contact was made with Licensee Designee Diane Smith. Ms. Smith was unaware of the situation and this consultant informed her that these violations would be substantiated. APPLICABLE RULE R 400.14304 Resident rights; licensee responsibilities. (1) Upon a resident's admission to the home, a licensee shall inform a resident or the resident's designated representative of, explain to the resident or the resident's designated representative, and provide to the resident or the resident's designated representative, a copy of all of the following resident rights: (o) The right to be treated with consideration and respect, with due recognition of personal dignity, individuality, and the need for privacy. ANALYSIS: Resident E does not have her right to privacy when Staff 1 s family is at the facility. Even though Resident E shuts her door, a family member bangs on it and this makes her nervous. Resident E stated that she is nervous when Staff 1 s family is at the facility. CONCLUSION: VIOLATION ESTABLISHED ADDITIONAL FINDINGS: On 10/19/2007, Licensee Designee Diane Smith reported that she retired from the business in August 2007 and that she wants her son Austin Smith to be the licensee designee of the business. This consultant was not aware that Ms. Smith had retired and no paperwork has been received. APPLICABLE RULE R 400.14103 Licenses; required information; fee; effect of failure to cooperate with inspection or investigation; posting of license; reporting of changes in information. (5) An applicant or licensee shall give written notice to the department of any changes in information that was 5
previously submitted in or with an application for a license, including any changes in the household and in personnelrelated information, within 5 business days after the change occurs. ANALYSIS: CONCLUSION: Licensee Designee Diane Smith told this consultant that she retired from the business. Paperwork has not been received advising that Austin Smith has been appointed the licensee designee. VIOLATION ESTABLISHED IV. RECOMMENDATION Upon submission of an acceptable corrective action plan, it is recommenced that the license of this adult foster care medium group home remains unchanged (capacity 1-12). Kathryn A. Huber Date: 10/25/2007 Licensing Consultant Approved By: Barbara C. Smalley Area Manager 10/26/2007 Date 6