STATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING JENNIFER M. GRANHOLM GOVERNOR ISMAEL AHMED DIRECTOR June 9, 2010 Anne Bueche Palmers Place Inc 1009 S St Johns Ithaca, MI 48847 RE: License #: Investigation #: AM290072779 2010A0777055 Palmers Place Inc Dear Ms. Bueche: 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. 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 (517) 241-2585. Sincerely, Dawn N. Timm, Licensing Consultant Bureau of Children and Adult Licensing 7109 W. Saginaw P.O. Box 30650 Lansing, MI 48909 (517) 335-6232 enclosure
I. IDENTIFYING INFORMATION MICHIGAN DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING SPECIAL INVESTIGATION REPORT License #: Investigation #: AM290072779 2010A0777055 Complaint Receipt Date: 05/05/2010 Investigation Initiation Date: 05/06/2010 Report Due Date: 07/04/2010 Licensee Name: Licensee Address: Palmers Place Inc 1009 S St Johns Ithaca, MI 48847 Licensee Telephone #: (989) 855-8784 Administrator: Licensee Designee: Name of Facility: Facility Address: Anne Bueche Anne Bueche Palmers Place Inc 1009 S St Johns Ithaca, MI 48847 Facility Telephone #: (989) 875-3745 Original Issuance Date: 10/01/1996 License Status: REGULAR Effective Date: 03/08/2010 Expiration Date: 03/07/2012 Capacity: 12 Program Type: AGED MENTALLY ILL DEVELOPMENTALLY DISABLED PHYSICALLY HANDICAPPED 1
II. ALLEGATION(S) There is no hot water in the north side of the facility. The hot water heater is not working. There are rugs put down to try to cover stains and they curl up at the edges and are a constant fall hazard. The carpet is in terrible condition, stained and smells. The owner/operator has not done sensitivity tests on the fire monitoring system. The owner/operator has not had a boiler inspection done. III. METHODOLOGY 05/05/2010 Special Investigation Intake 2010A0777055 05/06/2010 Special Investigation Initiated - Telephone Call made to Staff Member 1 05/12/2010 Contact - Telephone call made To Gratiot County Adult Protective Service- referral made 05/14/2010 Inspection Completed On-Site Interviews with Staff Members 2, 3, 4, and Residents A, B, and C 05/27/2010 Exit Conference with Anne Bueche 06/03/2010 Contact- Telephone call made to SM 2 There is no hot water in the north side of the facility. This complaint was received from an anonymous complainant on 05/05/2010. I made a referral to Gratiot County Adult Protective Services on 05/12/2010. I conducted an unannounced on-site inspection at the facility on 05/14/2010 and found that there was no hot water at any point in the facility. Neither the hot water heater located in the janitorial closet nor the one located in the basement was heating any water. Staff Member (SM) 2 and SM 3 both stated that they realized earlier that day that there was no hot water and a repair person was scheduled to fix it later in the afternoon. SM 2 stated that the basement is flooded which caused the pilot light in the basement hot water heater to go out. SM 2 was unsure why the hot water heater located on the main level of the facility was not working. 2
I interviewed Residents A, B, and C regarding their last hot shower. Resident A stated that he took a hot shower the previous evening on 05/13/2010 and Resident B stated that he took a hot shower that morning on 05/14/2010. Resident C also stated that she took a hot shower on 05/13/2010. Residents A and B both live on the north side of the facility. SM 4 noticed for the first time on the morning of 05/14/2010 that there was no hot water in the facility. SM 4 stated that he had gone down into the basement to look at the hot water heater and found the basement to be flooded. SM 2 stated that the she first learned of the flooded basement on 05/14/2010. SM 2 stated she was unsure of exactly when the basement had flooded but thought that it must have occurred during the overnight of 05/13/2010 because the facility had hot water until the morning of 05/14/2010. R 400.14401 Environmental health. (2) Hot and cold running water that is under pressure shall be provided. A licensee shall maintain the hot water temperature for a resident's use at a range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the faucet. ANALYSIS: There was no running hot water in the facility on 05/14/2010. VIOLATION ESTABLISHED The hot water heater is not working. During the on-site inspection on 05/14/2010, neither of the hot water heaters located in the facility was producing hot water. The pilot light on the hot water heater located in the basement was not working because the flooding in the basement had put it out. Neither SM 2 nor SM 3 knew what was wrong with the hot water heater located on the main level in the janitorial storage area. R 400.14403 Maintenance of premises. (6) All plumbing fixtures and water and waste pipes shall be properly installed and maintained in good working condition. Each water heater shall be equipped with a thermostatic temperature control and a pressure relief valve, both of which shall be in good working condition. 3
ANALYSIS: Neither hot water heater was in good working condition during the inspection on 05/14/2010. VIOLATION ESTABLISHED There are rugs put down to try to cover stains and they curl up at the edges and are a constant fall hazard. The floor mat located by the dining room entrance was curled at the end creating a tripping hazard for residents. SM 2 threw the floor mat away at the time of the investigation. R 400.14403 Maintenance of premises. (1) A home shall be constructed, arranged, and maintained to provide adequately for the health, safety, and well-being of occupants. ANALYSIS: The floor mat was curled at the end creating a tripping hazard for residents which endangers their safety. VIOLATION ESTABLISHED The carpet is in terrible condition, stained and smells. The carpeting throughout the facility is stained in multiple places. There is an exceptionally large black stain located in the south hallway that was covered by a floor mat. The stain is from wood varnish being spilled on the carpet and it is a permanent stain. I did not detect an odor from the carpet during the on-site inspection. Renewal Inspection Licensing Study Report substantiated violation of Rule 400.14403 (5) because at the time of the renewal inspection on 02/19/2010 the carpeting was stained in multiple places and in poor condition. The corrective action 4
plan stated that the carpet would be professionally cleaned by 04/30/2010. If this did not remove the stains, then the next plan would be to replace the carpeting by 06/30/2010. R 400.14403 Maintenance of premises. (5) Floors, walls, and ceilings shall be finished so as to be easily cleanable and shall be kept clean and in good repair. ANALYSIS: The carpeting is stained in multiple places with the worst stain located in the south hallway. This is a permanent stain leaving the carpeting in poor condition and not able to be cleaned. REPEAT VIOLATION ESTABLISHED. [REF. LSR RENEWAL INSPECTION DATED 02/22/2010] VIOLATION ESTABLISHED The owner/operator has not done sensitivity tests on the fire monitoring system. A review of the smoke detection equipment maintenance records documented that the last smoke detector sensitivity test was completed on 05/26/2009 for all of the detectors in the facility. The smoke detectors passed the sensitivity tests, so they were found to be working in accordance with the manufacturer s recommendations. This is completed annually and was up to date at the time of the on-site inspection on 05/14/2010. SM 2 was made aware that this would need to be updated by the end of May 2010. R 400.14505 Smoke detection equipment; location; battery replacement; testing, examination, and maintenance; spacing of detectors mounted on ceilings and walls; installation requirements for new construction, conversions and changes of category. (4) Detectors shall be tested, examined, and maintained as recommended by the manufacturer. 5
ANALYSIS: The smoke detector sensitivity tests were completed on 05/26/2009 and passed the inspection. Consequently, the detectors were maintained as recommended by the manufacturer. VIOLATION NOT ESTABLISHED The owner/operator has not had a boiler inspection done. I reviewed the maintenance records for the boiler system and found that the certificate of boiler inspection expired on 04/25/2010. The inspection is done once every three years to assure that the boiler is functioning safely and properly. I was not able to physically view the boiler because the water in the basement was too deep and the boiler could not be reached. R 400.14510 Heating equipment generally. (3) Where conditions indicate a need for inspection, heatproducing equipment shall be inspected by a qualified inspection service. A copy of the written approval from the qualified inspection service shall be submitted to the department and a copy shall be maintained in the adult foster care small group home and shall be available for department review. ANALYSIS: The certificate of boiler inspection expired on 04/25/2010. It is necessary that another inspection is completed to assure that the boiler is functioning safely and properly. VIOLATION ESTABLISHED ADDITIONAL FINDING: On 05/14/2010, I observed the basement of the facility to be completely flooded with at least three inches of water across the entire basement floor. SM 2 stated that she was told by the owner of the building that the sump pump would not work if it was not located in a specific spot in the basement, so SM 2 thought that might be the reason the basement flooded. On 06/03/2010, I interviewed SM 2 again regarding 6
the flooding of the basement and SM 2 stated that after I left the facility on 05/14/2010, Ithaca City Workers came to the facility to determine if the facility was the reason that surrounding homes were flooding as well. SM 2 stated that the facility switched to public sewer in Fall 2009 and the results of the city inspection on 05/14/2010 found that an error occurred when the facility was switched over. This error was causing excessive flooding to occur in the facility. SM 2 stated that once the issue was fixed on 05/14/2010, the sump pump began working properly and the water was out of the basement by the evening on 05/14/2010. SM 2 stated that since the error was fixed there has not been any additional flooding in the basement even though it has been raining excessively as it had when the basement flooded on 05/14/2010. SM 2 stated that once the water was out of the basement, the basement was cleaned and damaged materials were thrown out. R 400.14403 Maintenance of premises. (1) A home shall be constructed, arranged, and maintained to provide adequately for the health, safety, and well-being of occupants. ANALYSIS: The basement was flooded with approximately three inches of water on 05/14/2010 and had been flooded for approximately 24 hours at the time of my inspection on 05/14/2010. However, by the evening of 05/14/2010 the water had been pumped out of the basement, so there was no longer any standing water. VIOLATION NOT ESTABLISHED An exit conference was conducted with Anne Bueche on 05/27/2010. She stated that she had the carpet professionally cleaned since the inspection and that most of the stains came out of the carpet except the large black stain in the south hallway. She stated she is looking at other options for that hallway. Anne Bueche stated that the hot water heaters were fixed by the next day and hot water was restored to the facility. Anne Bueche also stated that the boiler was last inspected in March 2010 and that there is a sticker on the boiler, so she did not think that this rule should be cited as a violation. However, due to the basement being flooded I was unable to visually inspect the boiler. Consequently, Anne Bueche was given until June 1, 2010, to provide documentation that the boiler had been inspected. The documentation was not received in this office by that date. IV. RECOMMENDATION 7
Contingent upon receipt of an acceptable corrective action plan, I recommend that the status of the license remains unchanged. 06/09/2010 Dawn N. Timm Date Licensing Consultant Approved By: 6/9/10 Betsy Montgomery Date Area Manager 8