STATE OF MICHIGAN
GRETCHEN WHITMER
GOVERNOR DEPARTMENT OF LICENSING AND REGULATORY AFFAIRSLANSING
ORLENE HAWKS DIRECTOR
611 W. OTTAWA P.O. BOX 30664 LANSING, MICHIGAN 48909 www.michigan.gov/lara 517-335-1980 January 16, 2020 Shirley Smith 10340 Ataberry Dr Clio, MI 48420 RE: License #:
Investigation #: AS2502857782020A0501010 Ataberry Manor 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.
Please review the enclosed documentation for accuracy and contact me with any questions. In the event that I am not available and you need to speak to someone immediately, please contact the local office at (810) 787-7031.
Sincerely,
Crecendra Brown, Licensing Consultant Bureau of Community and Health Systems 4809 Clio Road
Flint, MI 48504 (810) 931-0965 enclosure
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MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF COMMUNITY AND HEALTH SYSTEMS
SPECIAL INVESTIGATION REPORT I. IDENTIFYING INFORMATION
License #: AS250285778
Investigation #: 2020A0501010
Complaint Receipt Date: 11/25/2019
Investigation Initiation Date: 11/25/2019
Report Due Date: 01/24/2020
Licensee Name: Shirley Smith
Licensee Address: 10340 Ataberry Dr Clio, MI 48420
Licensee Telephone #: (810) 814-3212
Administrator: Shirley Smith
Licensee Designee: N/A
Name of Facility: Ataberry Manor
Facility Address: 10340 Ataberry Dr Clio, MI 48420
Facility Telephone #: (810) 686-8989
Original Issuance Date: 11/27/2006
LicenseStatus: REGULAR
Effective Date: 06/19/2019
Expiration Date: 06/18/2021
Capacity: 6
Program Type: PHYSICALLY HANDICAPPED DEVELOPMENTALLY DISABLED MENTALLY ILL
II. ALLEGATION(S)
III. METHODOLOGY
11/25/2019 Special Investigation Intake 2020A0501010
11/25/2019 Special Investigation Initiated - Letter
11/27/2019 Contact - Telephone call made
Complainant 1.
01/02/2020 Inspection Completed On-site
Licensee Shirley Smith, Resident A, Resident B, Resident C, Resident D and Resident E.
01/02/2020 Contact - Telephone call made
Guardian A.
01/02/2020 Exit Conference
Licensee Shirley Smith.
01/13/2020 APS Referral
Made APS Referral to Centralized Intake.
Violation Established? On November 23, 2019, Resident A left the house in the morning
on Your Ride for work and no staff were awake to give him his medications.
Yes AFC home is not providing Resident A with dinner when he gets
home from work.
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ALLEGATION:
On November 23, 2019, Resident A left the house in the morning on Your Ride for work and no staff were awake to give him his medications.
INVESTIGATION:
On November 27, 2019, I conducted a phone interview with Complainant 1. Complainant 1 stated that Resident A did not receive his morning medications on
November 23, 2019, because the AFC home staff were sleeping. Complainant 1 stated that Resident A is picked up early in the morning by Your Ride to go to work and no staff were awake to give him his morning medications.
On January 2, 2020, I conducted an onsite investigation at Ataberry Manor. Licensee Shirley Smith, Resident A, Resident B, Resident C, Resident D and Resident E were interviewed.
Licensee Shirley Smith stated that Resident A did leave the home early that day before 6am and he did not get his medications. Licensee Smith stated that the residents are never left alone to take their own medications. Licensee Smith stated that it has not happened anymore and she has been making sure he receives his medications. Resident A stated that the allegation was true. Resident A stated that no one was awake that morning when he left to go to work so he did not get his morning medications. Resident A stated that it happened more than once, but it has not
happened recently. Resident A stated that the staff always administer the medications to the residents. Resident A stated that Licensee Smith and her husband live at the home.
I reviewed Resident A’s medication logs. Resident A’s morning medications are Fluoxetine HCL (Prozac) 10mg and Amphetamine Salt (Adderall) 20mg tablets. Medication log shows that the medications, in November 2019 and December 2019, were never missed and Resident A takes his medications with him on the weekends he visits Guardian A. November 23, 2019 on Resident A’s medication log is marked as administered.
Resident B was nonverbal and not appropriate for interviewing. Resident B was clean and dressed appropriately. Resident B’s room was clean and well organized.
Resident C stated that staff always administer the medications. Resident C stated that staff are always at the home and he has not missed any medications. Resident C stated that he receives his medications when he goes to visit his family.
Resident D stated that they are never left home alone. Resident D stated that the medications are always locked up. Resident D stated that the medications are always
administered by the staff. Resident D stated that she didn’t know anything about anyone not getting their medications.
Resident E stated that she was doing good. Resident E stated that she receives her medications every day. Resident E stated that she didn’t know anything about anyone not getting their medications.
On January 2, 2020, I conducted a phone interview with Guardian A. Guardian A stated that she had never heard Resident A was not given some of his medications in the morning. Guardian A stated that staff are always at the home that she knows of and they take care of the medications. Guardian A stated that Resident A seems to be doing alright at the home.
APPLICABLE RULE
R 400.14312 Resident medications. Resident medications.
(1) Prescription medication, including dietary supplements, or individual special medical procedures shall be given, taken, or applied only as prescribed by a licensed physician or dentist. Prescription medication shall be kept in the original pharmacy-supplied container, which shall be labeled for the specified resident in accordance with the requirements of Act No. 368 of the Public Acts of 1978, as amended, being {333.1101 et seq. of the Michigan Compiled Laws, kept with the equipment to administer it in a locked cabinet or drawer, and refrigerated if required.
(2) Medication shall be given, taken, or applied pursuant to label instructions.
(3) Unless a resident's physician specifically states otherwise in writing, the giving, taking, or applying of prescription medications shall be supervised by the licensee, administrator, or direct care staff.
ANALYSIS: Licensee Shirley Smith and Resident A stated that Resident A did leave the home early one morning and he did not receive his morning medications.
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ALLEGATION:
AFC home is not providing Resident A with dinner when he gets home from work.
INVESTIGATION:
On November 27, 2019, I conducted a phone interview with Complainant 1.
Complainant 1 stated that Licensee Shirley Smith is not feeding Resident A dinner when he gets home from work. Complainant 1 stated that Licensee Smith wants all the
residents to eat dinner by 7pm, but Resident A doesn’t get off from work sometimes until 10pm.
On January 2, 2020, I conducted an onsite investigation at Ataberry Manor. Licensee Shirley Smith, Resident A, Resident B, Resident C, Resident D and Resident E were interviewed.
Licensee Shirley Smith stated that Resident A works at Kroger Grocery Store and sometimes he does not arrive home until 10pm. Licensee Smith stated that Resident A is not always hungry when he arrives home from work. Licensee Smith stated that she has started making sure that when Resident A leaves in the morning he is packed extra food in his lunch for dinner. Licensee Smith stated that she will make sure they make a plate for him every night regardless of what time he gets home from work.
Resident A stated that the kitchen at the home shuts down at 7pm. Resident A stated that when he gets off from work at 10pm Licensee Smith does not want to open the kitchen back up. Resident A stated that he has to now pack extra food in his lunch, but he did not receive anything a few times for dinner. Resident A stated that recently Licensee Smith has started asking him if he wants anything to eat when he gets home from work. Resident A stated that he goes to his Day Program and then straight to work from there. Resident A stated that he rides Your Ride to and from work when he goes. Resident B was nonverbal and not appropriate for interviewing. Resident B was clean and dressed appropriately. Resident B’s room was clean and well organized.
Resident C stated that they eat dinner every night before 7 pm. Resident C stated that Resident A is gone to work sometimes when they eat. Resident C stated that he was not sure if Resident A was getting anything to eat at night when he gets home from work.
Resident D stated that they eat dinner together every night. Resident D stated that Resident A gets extra food packed in his lunch for the day because he works at night. Resident D stated that she has never seen an extra plate made for Resident A when he is at work and the kitchen is closed after they eat dinner.
Resident E stated that Resident A is gone to work sometimes when they eat dinner. Resident E stated that everything is cleaned up after they eat dinner and she does not
know anything about any extra plates being made. Resident E stated that she doesn’t know if Resident A gets anything to eat when he gets home from work.
On January 2, 2020, I conducted a phone interview with Guardian A. Guardian A stated that there was a problem at the home with Resident A not getting dinner at night.
Guardian A stated that she was told there was an issue with Resident A getting off from work after 10pm and the home dinner time. Guardian A stated that she had started giving Resident A extra money to buy food on his way home from work. Guardian A stated that Resident A did not receive anything to eat for dinner a few times. It is her understanding that it does not happen anymore and she will be asking Resident A on a regular basis because he is hungry when he gets off from work.
On January 2, 2020, I conducted a face-to-face exit conference with Licensee Shirley Smith at Ataberry Manor. I informed Licensee Shirley Smith that a corrective action plan would be requested for the violations. Licensee Shirley Smith stated that she would be completing the corrective action plan.
APPLICABLE RULE
R 400.14313 Resident nutrition. Resident nutrition.
(1) A licensee shall provide a minimum of 3 regular, nutritious meals daily. Meals shall be of proper form, consistency, and temperature. Not more than 14 hours shall elapse between the evening and morning meal. (2) Meals shall meet the nutritional allowances
recommended pursuant to the provisions of "Appendix I: Recommended Dietary Allowances, Revised 1980"
contained in the publication entitled "Basic Nutrition Facts: A Nutrition Reference," Michigan Department of Public Health publication no. H-808, 1/89. This publication may be obtained at cost from The Division of Research and
Development, Michigan Department of Public Health, P.O. Box 30195, Lansing, Michigan 48909.
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ANALYSIS: Licensee Shirley Smith stated that sometimes when Resident A came home from work he said he was not hungry and did not eat.
Guardian A and Resident A stated that Resident A was not provided dinner a few times because he arrived home from work after 10pm.
Resident D and Resident E stated that the kitchen is closed every night after they eat dinner.
CONCLUSION: VIOLATION ESTABLISHED
IV. RECOMMENDATION
Upon the receipt of an acceptable and approved corrective action plan, no change to the license status is recommended.
January 16, 2020 ________________________________________ Crecendra Brown Licensing Consultant Date Approved By: January 16, 2020 ________________________________________ Mary E Holton
