State of Michigan DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING RICK SNYDER
MAURA D. CORRIGAN
GOVERNOR
DIRECTOR
November 9, 2011 Stella Mier Golden Years Ret Homes Inc. P.O. Box 367 2791 Main Marlette, MI 48453
RE: License #: AL760016105 Investigation #: 2012A0872003 Premier Adult Foster Care
Dear Ms. Mier: Attached is the Special Investigation Report for the above referenced facility. This investigation has resulted in a finding that a substantial violation has occurred. The violation summarized in this report will be included as an additional finding to the previous recommendation for license revocation. 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 (989) 758-2717. Sincerely,
Susan Sells, Licensing Consultant Bureau of Children and Adult Licensing 411 Genesee P.O. Box 5070 Saginaw, MI 48605 (989) 758-2743 enclosure
P.O. BOX 30650 • LANSING, MICHIGAN 48909-8150 www.michigan.gov • (517) 335-6124
MICHIGAN DEPARTMENT OF HUMAN SERVICES BUREAU OF CHILDREN AND ADULT LICENSING SPECIAL INVESTIGATION REPORT THIS REPORT CONTAINS QUOTED PROFANITY
I. IDENTIFYING INFORMATION License #:
AL760016105
Investigation #:
2012A0872003
Complaint Receipt Date:
10/19/2011
Investigation Initiation Date:
10/19/2011
Report Due Date:
12/18/2011
Licensee Name:
Golden Years Ret Homes Inc.
Licensee Address:
P.O. Box 367 2791 Main Marlette, MI 48453
Licensee Telephone #:
810-834-2315
Administrator:
Stella Mier, Designee
Licensee Designee:
Stella Mier, Designee
Name of Facility:
Premier Adult Foster Care
Facility Address:
2791 Main Marlette, MI 48453
Facility Telephone #:
(989) 635-7740
Original Issuance Date:
12/22/1994
License Status:
1ST PROVISIONAL
Effective Date:
12/21/2010
Expiration Date:
06/20/2011
Capacity:
20 1
Program Type:
II.
ALLEGATION(S) • •
III.
PHYSICALLY HANDICAPPED, MENTALLY ILL, DEVELOPMENTALLY DISABLED, AGED
Most of the residents are not receiving nutritious meals. The licensee will buy subs and pizza for the private pay residents but only feeds the other residents ramen noodles or other non-nutritious foods. On 10/16/2011, Resident A “got into a fight” with Denise Schank, Direct Care Staff. Ms. Schank pulled Resident A’s hair and bent her hand back resulting in swelling and bruising to Resident A’s hand.
METHODOLOGY 10/19/2011
Special Investigation Intake 2012A0872003
10/19/2011
Special Investigation Initiated - Telephone I telephoned Sanilac County RRO and left her a message with the allegations
10/19/2011
Referral - Protective Services I e-mailed the Sanilac County Adult Protective Services Supervisor with the allegations
10/19/2011
Contact - Telephone call received I spoke to the Adult Protective Services Worker, Karin Cook and made arrangements to meet her at the AFC facility
10/19/2011
Inspection Completed On-site I interviewed the licensee and Residents A, C, D, E, F, H and J. I also observed Resident I
10/21/2011
Contact - Face to Face I re-interviewed the licensee and interviewed Residents B and G
10/27/2011
Contact - Telephone call made I interviewed staff member, Dwayne Hall by phone
10/27/2011
Contact - Face to Face I re-interviewed the licensee and Resident A and interviewed staff member, Lourdes Mier
10/31/2011
Contact - Telephone call received I interviewed staff member, Denise Schank by phone
11/03/2011
Contact - Telephone call made 2
I re-interviewed Mr. Hall by phone 11/03/2011
Contact - Telephone call made I telephoned Dr. Frank Horvat and left a message
11/03/2011
Contact - Telephone call made I telephoned Resident A’s guardian, Karla Roberts
11/04/2011
Contact – Telephone call received I interviewed Dr. Horvat by phone
11/04/2011
Contact – Telephone call received I spoke to Ms. Cook by phone
11/07/2011
Exit Conference— I conducted an exit conference via telephone with the licensee
ALLEGATION: Most of the residents are not receiving nutritious meals. The licensee will buy subs and pizza for the private pay residents but only feeds the other residents ramen noodles or other non-nutritious foods. INVESTIGATION: On 10/19/2011, Adult Foster Care Licensing Consultant, Kay Huber, Adult Protective Services Worker, Karin Cook and I conducted an on-site inspection of this facility. We interviewed the licensee, Stella Mier and residents A, C, D, E, F, H and J and observed Resident I. I also reviewed and obtained copies of the Resident Weight Records for all residents and the facility’s menus from August 2011 until the present. According to Resident A, Ms. S. Mier feeds Residents D, G and H “better than the rest of us.” Resident A said that Ms. S. Mier takes them to get pizza or makes steak for residents D, G and H but the rest of the residents have to eat whatever staff makes for them. Resident A said she usually does not like the food served at this facility. Resident C said that meals are “decent” and he has “no complaints” about the food. Resident D said that the “meals are great.” Resident D said that he saves his spending money so he can go out occasionally and buy a sub or “pitch in” with residents G and H to buy pizza out of their own money. Resident D stated that Ms. S. Mier does not purchase special food solely for them. He said that sometimes it “takes forever” for staff to serve lunch and that Resident A is “extremely picky” and does not typically eat what staff make for meals.
3
According to Resident E, the food “isn’t good.” Resident E said they are served spaghetti or macaroni without sauce and this happens “a lot.” I interviewed Resident F but because of her difficulty communicating, I did not obtain any information from her regarding these allegations. Resident H said that the food “is pretty good” and they are given “decent” portions. If a resident asks for another serving at mealtime, he or she will “sometimes get it” but at other times, they are told there is no more food. Resident H said that some of the residents have control over their own money and choose to buy pizza or subs but Ms. S. Mier does not use her own money to purchase “special” food for any of the residents. According to Resident H, when this occurs the residents with the pizza or subs will eat their meal in their rooms so they are not eating in front of the other residents. I observed Resident I but was unable to interview him due to his limited ability to communicate. Resident J said that meals are “good” and he “sometimes” get seconds if he asks. I reviewed and obtained copies of all of the Resident Weight Records from 2010 to the present and did not see any significant weight loss or gain for any of the residents. I reviewed and obtained copies of the facility’s menus from August 2011 to the present. All of the menus specify what is served for breakfast, lunch, dinner and daily snacks. Ms. S. Mier indicates that she follows the nationally recommended nutritional guidelines and updates the menus as necessary. Ms. S. Mier also showed me the cupboards and refrigerator/freezer and there appeared to be an ample amount of food in the home. On 10/21/2011, Ms. Cook and I re-interviewed Ms. S. Mier and interviewed Resident B and Resident G. Resident B said that she has cereal for breakfast most days and “whatever they serve” for lunch. She said that she gets “the runs” sometimes because the meals “aren’t very nutritious.” Resident B said that they get “a thin piece of meat” or a hamburger for dinner and the other residents do not feel that they are getting enough to eat either. According to Resident B, she’s lost 45lbs but was unable to give a time frame for her weight loss. According to the AFC-Resident Information and Identification Record, Resident B was placed in this AFC home in August 2011. According to her Resident Weight Record she has gained ½ pound since her placement date. Resident G said that meals are served on time and he feels like he gets enough to eat. According to Resident G, spaghetti is served 2-3 times per month and sauce is provided as well. Resident G said that he and some of the other residents use their own money to buy pizza or subs but Ms. S. Mier does not buy or provide special food for any of the residents.
4
APPLICABLE RULE R 400.15304 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: (a) The right to be free from discrimination on the basis of race, religion, color, national origin, sex, age, handicap, marital status, or source of payment in the provision of services and care. (2) A licensee shall respect and safeguard the resident’s rights specified in subrule (1) of this rule. ANALYSIS:
All of the residents are served the same meals. Some of the residents choose to use their spending money to purchase pizza or subs but the licensee is not purchasing special foods for any of the residents.
CONCLUSION:
VIOLATION NOT ESTABLISHED
R 400.15313
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.
ANALYSIS:
Based on the facility’s menus, the licensee is providing adequate meals to the residents. According to the Resident Weight Records, none of the residents have gained or lost a significant amount of weight while at this facility.
CONCLUSION:
VIOLATION NOT ESTABLISHED
ALLEGATION: On 10/16/2011, Resident A “got into a fight” with Denise Schank, Direct Care Staff. Ms. Schank pulled Resident A’s hair and bent her hand back resulting in swelling and bruising to Resident A’s hand. INVESTIGATION:
5
On 10/19/2011, Adult Foster Care Licensing Consultant, Kay Huber, Adult Protective Services Worker, Karin Cook and I conducted an on-site investigation at this facility. We interviewed the licensee, Stella Mier and residents A, C, D, E, F, H and J and observed Resident I. According to Resident A, on 10/16/2011 at approximately 7:30pm, she went to get Resident E’s newspaper that had been thrown in the trash. Resident A said that Ms. Schank became angry with her and said that the newspaper needed to go back in the trash. Resident A said that she and Ms. Schank “fought” and Ms. Schank pulled out a “wad” of Resident A’s hair and bent three of her fingers back. I observed that Resident A’s left hand appeared to be bruised and swollen and observed a small cut/mark by her pinkie finger knuckle. Resident A said that as of this date, she has not received any medical attention. Resident A said that one of the other staff members, Lourdes Mier “might have” seen the incident occur but there were no other witnesses. According to Resident A, sometime later that day, she told the licensee what happened but said that the licensee “doesn’t care.” Resident C said that he has seen Resident A argue with Ms. Schank but has never seen any of the staff physically assault Resident A. Resident D said that Ms. Schank “is the best employee” and he has never seen her be physically inappropriate with any of the residents. Resident D said that Resident A does not listen to staff and she will not cooperate with “anyone” in the home. Resident D denies seeing any of the staff be physically inappropriate with Resident A. Residents E, H and J all deny witnessing Ms. Schank or any of the other staff being physically inappropriate with Resident A. On 10/21/2011, Ms. Cook and I re-interviewed Ms. S. Mier and interviewed residents B and G. Both residents B and G deny seeing Ms. Schank or any other staff being physically inappropriate with Resident A. Initially during this interview, Ms. S. Mier told us that she was not aware of the physical abuse allegations involving Ms. Schank and Resident A until after our first onsite visit on 10/19/2011. Ms. S. Mier said that after we left, she talked to Resident A, Ms. Schank and the other residents and looked at Resident A’s hand. Later during our interview, Ms. S. Mier said that on 10/17/2011 she was told by one of the other staff members, Dwayne Hall that on 10/16/2011 Ms. Schank “beat (Resident A) up” and “pulled her hair out of her head.” Ms. S. Mier said that she looked at Resident A’s hand on 10/18/2011 and saw that her hand appeared to be bruised and puffy. Ms. S. Mier said that she also saw a scratch on Resident A’s hand and up her
6
arm. Ms. S. Mier said that she offered to take Resident A to the Emergency Room but Resident A declined. Ms. S. Mier said that Dr. Frank Horvat was at the home on 10/20/2011 and he looked at Resident A’s hand. According to Ms. S. Mier, Dr. Horvat advised her to give Resident A a 30-day notice but did not offer any advice to treat Resident A’s hand. On 10/27/2011 and 11/03/2011, I spoke to Mr. Hall by telephone. Mr. Hall said that on 10/17/2011 the midnight shift staff told him that Resident A said that Ms. Schank had physically assaulted her. Mr. Hall said that on 10/17/2011 at approximately 8:30am he went to give Resident A her medications and she complained of pain in her hand. Mr. Hall said that according to Resident A, “Denise beat me up and pulled my hair out of my head and bent my fingers back.” Mr. Hall said that Resident A’s hand did appear to be injured. Mr. Hall said that he filled out an Incident/Accident Report and notified the licensee at approximately 9:30am on 10/17/2011. Mr. Hall said that he told the licensee that Resident A’s hand appeared to be injured and asked the licensee to look at it. Mr. Hall said that the licensee said she would look at it later. According to Mr. Hall, when the licensee returned to the home later on during the day, he again asked her to look at Resident A’s hand to determine if she needed medical attention. Mr. Hall said that the licensee did not look at Resident A’s hand but told him to fill out an Incident/Accident Report. On 10/27/2011, Ms. Cook and I re-interviewed the licensee and Resident A and interviewed staff member, Lourdes Mier at the facility. Initially, Resident A said that she has still not seen a doctor regarding her hand. Eventually she said that she did see a doctor who told her that there was “nothing wrong” with her hand. Ms. L. Mier said that she was at the home on 10/16/2011 and Ms. Schank was working. Ms. L. Mier said that she went downstairs to talk to Ms. S. Mier and when she came back upstairs, she heard Ms. Schank saying “no (Resident A), don’t just grab the papers. Ask me for them and I’ll give them to you.” Ms. L. Mier said that she heard Resident A “cussing” at Ms. Schank but said that she did not see a physical altercation take place. Ms. L. Mier said that she talked to Ms. Schank and asked her why Resident A was angry and upset. Ms. L. Mier said that Ms. Schank told her that Resident A grabbed the papers away from her so she grabbed them back. Ms. L. Mier said that she went downstairs and told Ms. S. Mier what was going on so Ms. S. Mier came upstairs and talked to both Ms. Schank and Resident A about the incident. Ms. L. Mier said that Ms. Schank told Ms. S. Mier that Resident A grabbed the newspaper from her. Ms. L. Mier said that Resident A told Ms. S. Mier “Look what she did to my hand!” Ms. L. Mier said that Ms. S. Mier looked at Resident A’s hands and arms and said “your arms and hand are all red—why are they all red?” and Resident A responded, “Ask Denise why
7
they’re all red!” Ms. L. Mier said that Resident A also told Ms. S. Mier that Ms. Schank pulled her hair and told Ms. S. Mier that she has the hair in a baggie. On 10/31/2011, I spoke to Ms. Schank by telephone. Ms. Schank said that on 10/16/2011 she was sitting at the dining room table reading her newspaper. All of the residents were in bed except for residents A, B and C. According to Ms. Schank, Resident A came up to her, grabbed the newspaper out of her hand, and went and sat at a different table. Ms. Schank went over to Resident A, told her she was rude for taking the papers, and asked her to give them back. Resident A said “No! Fuck you it’s mine now!” Ms. Schank said, “No, I brought that paper from home and if you want to look at it when I’m done you can.” Resident A threw the newspaper at her and said, “Fine, you can have it back you fucking bitch!” and she “stormed off” to her room. Ms. Schank said that she never put her hands on Resident A at any time during the incident. Ms. Schank said that she filled out an Incident/Accident Report and gave it to the licensee before leaving that night. On 11/04/2011, I spoke to Dr. Horvat by telephone. According to Dr. Horvat, on 10/20/2011 he examined Resident A at the AFC facility during a routine visit. Dr. Horvat said that during the visit, Resident A said that she had been “physically assaulted” by two staff members. Resident A told him that Ms. Schank pulled out her hair and Mr. Hall “beat her up.” Resident A offered to show him the hair, which she kept in a baggie but when Dr. Horvat agreed to see it, Resident A changed her mind and refused to show him. Dr. Horvat said that he looked at Resident A’s hand and there was no physical evidence of assault at the time of this visit. According to Dr. Horvat, Resident A has a habit of picking at her hands and causing sores and possibly infection. For that reason, in September 2011, Dr. Horvat prescribed a cream for Resident A’s hand and advised that it be applied daily. Dr. Horvat said that Resident A’s hand still showed evidence of the sores that he had seen during his last visit in September 2011.
APPLICABLE RULE R 400.15308 Resident behavior interventions prohibitions. (2) A licensee, direct care staff, the administrator, members of the household, volunteers who are under the direction of the licensee, employees, or any person who lives in the home shall not do any of the following: (a) Use any form of punishment. (b) Use any form of physical force other than physical restraint as defined in these rules. (c) Restrain a resident's movement by binding or tying or through the use of medication, paraphernalia, contraptions, material, or equipment for the purpose of immobilizing a resident. (d) Confine a resident in an area, such as a room, where egress is prevented, in a closet, or in a bed, box, or chair or
8
restrict a resident in a similar manner. (e) Withhold food, water, clothing, rest, or toilet use. (f) Subject a resident to any of the following: (i) Mental or emotional cruelty. (ii) Verbal abuse. (iii) Derogatory remarks about the resident or members of his or her family. (iv) Threats. (g) Refuse the resident entrance to the home. (h) Isolation of a resident as defined in R400.15102(1)(m). (i) Any electrical shock device. ANALYSIS:
Resident A said she was physically assaulted by staff member, Denise Schank. Ms. Schank denied physically assaulting Resident A. Dr. Horvat examined Resident A’s hand and said that there was no physical evidence of abuse. I interviewed all of the residents and none of them witnessed the alleged incident and stated that they have never seen Ms. Schank be physically inappropriate with Resident A. I interviewed the licensee and staff members Mr. Hall and Ms. L. Mier and all of them said they did not see Ms. Schank physically assault Resident A nor have they ever seen Ms. Schank being physically inappropriate with Resident A.
CONCLUSION:
VIOLATION NOT ESTABLISHED
ADDITIONAL FINDINGS: The licensee did not report an allegation of physical abuse of a resident by a staff member pursuant to Rule 400.15311. INVESTIGATION: On 10/19/2011, Adult Foster Care Licensing Consultant, Kay Huber, Adult Protective Services Worker, Karin Cook and I interviewed Resident A. According to Resident A, sometime on 10/16/2011 she told the licensee that she had been physically assaulted by Ms. Schank but said the licensee “doesn’t care.”
9
On 10/21/2011, Ms. Cook and I interviewed the licensee, Ms. S. Mier. Initially during this interview, Ms. S. Mier told us that she did not become aware that Resident A was alleging that she was physically assaulted by Ms. Schank until after our first onsite visit on 10/19/2011. Ms. S. Mier said that on that date after we left, she talked to Resident A, Ms. Schank and the other residents and looked at Resident A’s hand. Later during our interview, Ms. S. Mier said that on 10/17/2011 she was told by Mr. Hall that on 10/16/2011 Ms. Schank “beat (Resident A) up and “pulled her hair out of her head.” Ms. S. Mier said that she looked at Resident A’s hand on 10/18/2011 and saw that her hand appeared to be bruised and puffy. Ms. S. Mier said that she also saw a scratch on Resident A’s hand and up her arm. Ms. S. Mier said that she offered to take Resident A to the Emergency Room but Resident A declined. On 10/27/2011 and 11/03/2011, I spoke to Mr. Hall by telephone. Mr. Hall said that after learning of the physical abuse allegations Resident A made against Ms. Schank, he filled out an Incident/Accident Report and notified the licensee at approximately 9:30am on 10/17/2011. Mr. Hall said that he told the licensee that Resident A’s hand appeared to be injured and asked the licensee to look at it. Mr. Hall said that the licensee was in a hurry (she told him she was going to look at some homes to purchase) and would look at it later. Mr. Hall said that when the licensee returned to the home later on during the day, he again asked her to look at Resident A’s hand to determine if she needed medical attention. Mr. Hall said that the licensee did not look at Resident A’s hand and told Mr. Hall to fill out an Incident/Accident Report. On 10/27/2011, Ms. Cook and I interviewed Ms. L. Mier at the facility. Ms. L. Mier said that she became aware of the incident between Resident A and Ms. Schank on 10/16/2011. Ms. L. Mier said that she told Ms. S. Mier about the incident and Ms. S. Mier talked to both Ms. Schank and Resident A on that date. Ms. L. Mier said that Ms. S. Mier also looked at Resident A’s hand and commented on the injury. On 10/31/2011, I interviewed Ms. Schank by telephone. Ms. Schank said that she filled out an Incident/Accident Report on 10/16/2011 regarding the incident in question and gave it to Ms. S. Mier on that date. On 11/04/2011, I spoke to Dr. Horvat by telephone. Dr. Horvat said that during a routine visit to this home on 10/20/2011, Resident A told him that her hand was injured during a physical altercation with Ms. Schank. Dr. Horvat said that this is the first time he became aware of the incident. On 10/21/2011 and 10/27/2011, Ms. S. Mier provided me with copies of Incident/Accident Reports and the Physician Visit Log/Record regarding Resident A. The first report is dated 10/16/2011 at 9:30pm and was filled out by Ms. Schank. That report documents that Resident A took the newspaper from Ms. Schank but there was no mention of a physical altercation.
10
The next Incident/Accident Reports are dated 10/17/2011. Both reports were filled out by Mr. Hall and document the incident that took place on 10/16/2011 as relayed to him by Resident A. Although both reports document the same incident, one of the reports has additional information hand-written in the “persons notified” section. Although the original report says that Mr. Hall notified “the homeowner,” the second, altered report says, “Did not tell one Stella Mier homeowner until 3:45pm on 10/17/2011 about her hand.” The second report also has hand-written that Ms. S. Mier notified Adult Foster Care Licensing Consultant, Susan Sells on 10/17/2011 at 4:00pm. However, I, Susan Sells did not receive notification on that date. Additionally, the second report has handwritten that Ms. S. Mier left a message for Dr. Horvat regarding the incident. The next Incident/Accident Reports are dated 10/17/2011 at 3:45pm. Although both reports document the same incident, one of the reports has additional information handwritten at different places throughout the report. Ms. S. Mier wrote those reports and documented that on 10/17/2011 Mr. Hall told her that Resident A was making physical abuse allegations against Ms. Schank. In that report, Ms. S. Mier wrote that she looked at Resident A’s hand on 10/17/2011 and wrote, “It was just looking like she had been picking it again.” Another Incident/Accident Report dated 10/20/2011 at 11:05am was completed by Ms. S. Mier. That report documents Dr. Horvat’s visit to the facility and states that Ms. S. Mier told Dr. Horvat about Resident A’s hand. Ms. S. Mier provided me with two copies of the Physician Visit Log/Record regarding Resident A. Both documents appear to be identical copies up until the last entry dated 10/20/2011. The “recommendations/follow up care” is different on both of them. One of the documents says, “Has a bruce (appears to be a misspelling for “bruise”) on hand and open sore again” while the second one says “She has a sore on her hand and bruce. Seen Dr. Horvat.” R 400.15311
Investigation and reporting of illnesses, absences, and death.
incidents,
accidents,
(1) A licensee shall make a reasonable attempt to contact the resident's designated representative and responsible agency by telephone and shall follow the attempt with a written report to the resident's designated representative, responsible agency, and the adult foster care licensing division within 48 hours of any of the following: (b) Any accident or illness that requires hospitalization. (c) Incidents that involve any of the following: (i) Displays of serious hostility. (ii) Hospitalization. (iii) Attempts at self-inflicted harm or harm to others. (iv) Instances of destruction to property.
11
(d) Incidents that involve the arrest or conviction of a resident as required pursuant to the provisions of section 1403 of Act No. 322 of the Public Acts of 1988. (2) An immediate investigation of the cause of an accident or incident that involves a resident, employee, or visitor shall be initiated by a group home licensee or administrator and an appropriate accident record or incident report shall be completed and maintained. (6) An accident record or incident report shall be prepared for each accident or incident that involves a resident, staff member, or visitor. "Incident" means a seizure or a highly unusual behavior episode, including a period of absence without prior notice. An accident record or incident report shall include all of the following information: (a) The name of the person who was involved in the accident or incident. (b) The date, hour, place, and cause of the accident or incident. (c) The effect of the accident or incident on the person who was involved and the care given. (d) The name of the individuals who were notified and the time of notification. (e) A statement regarding the extent of the injuries, the treatment ordered, and the disposition of the person who was involved. (f) The corrective measures that were taken to prevent the accident or incident from happening again. (7) A copy of the written report that is required pursuant to subrules (1) and (6) of this rule shall be maintained in the home for a period of not less than 2 years. A department form shall be used unless prior authorization for a substitute form has been granted, in writing, by the department.
12
ANALYSIS:
Ms. Schank and Mr. Hall said that Ms. S. Mier became aware of the physical abuse allegations on 10/16/2011. Mr. Hall said that he again notified Ms. S. Mier of the physical abuse allegations and injury to Resident A’s hand on 10/17/2011. Ms. S. Mier provided me with several different accounts as to when she became aware of the physical abuse allegations regarding Ms. Schank and Resident A. Ms. S. Mier did not notify a medical professional or myself regarding the physical abuse allegations and did not initiate an investigation regarding the allegations. Ms. S. Mier altered AFC documents regarding notification dates and times regarding this incident.
CONCLUSION:
IV.
VIOLATION ESTABLISHED
RECOMMENDATION I recommend that the previous recommendation of revocation of the license remain
11/09/2011 ________________________________________ Susan Sells Date Licensing Consultant Approved By: 11/09/2011 ________________________________________ Jerry Hendrick Date Area Manager
13
