STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF COMMUNITY AND HEALTH SYSTEMS In the matter of License #: AL820282884 SIR#: 2016A0121032 Berkley Court of Livonia LLC DBA Ashley Court ‘Surinder Chandok, Licensee Designee Berkley Court Ill ORDER OF SUMMARY SUSPENSION AND NOTICE OF INTENT TO REVOKE LICENSE The Michigan Department of Licensing and Regulatory Affairs, by Jay Calewarts, Division Director, Adult Foster Care and Camps Licensing Division, Bureau of Community and Health Systems, orders the summary suspension and provides notice of the intent to revoke the license of Licensee, Berkley Court of Livonia LLC DBA Ashley Court, to operate an adult foster care large group home pursuant to the authority of the Adult Foster Care Facility Licensing Act, 1979 PA 218, as amended, MCL 400.701 et seq., for the following reasons: 4, On or about May 23, 2007, Licensee was issued a license to operate an adult foster care large group home with a licensed capacity of 20 at 32406 W. Seven Mile Rd., Livonia, MI 48152. 2. Prior to the issuance of the license, and during subsequent modifications of the statutes and rules, Licensee received copies of the Adult Foster Care Facility Licensing Act and the licensing rule book foradult foster care large group homes. The Act and rule book are posted and available for download at www.michigan.govilara. Previous Licensing Rule Violations . On February 19, 2016, Licensing Consultant Edith Richardson completed a Licensing Study Report for the adult foster care large group home called Berkley Court Ill, icensed by Berkley Court of Livonia LLC DBA Ashley Court. Ms. Richardson cited Licensee with 13 licensing rule violations, including the following: a. R 400.15204(3)(a-g); Two direct care staff (DCS) were not trained in first aid and cardiopulmonary resuscitation; b. R 400.15205(6); Licensee failed to obtain TB test results for DCS Ravin Solomon prior to her employment; c, R400.5403(1); The state fire marshal gave the facility Berkley Court Ill a temporary approval due to 20 fire safety deficiencies. On March 21, 2016, Licensee submitted an acceptable Corrective Action Plan (CAP) to show compliance with the cited licensing rule violations. On March 24, 2016, the license for Berkley Court II was modified to ‘st provisional status for a period of six months. Current Licensing Rule Violations . On March 18, 2016, State Fire Marshal Inspector Larry DeWachter completed 2015 Annual Fire Safety Inspection of the facility Berkley Court Ill and cited the facility with nine fire safety deficiencies. Inspector DeWachter stated the following in his inspection report: "A second recheck fire safety inspectionwas completed on this date. All deficiencies previously noted have not been corrected within the time period(s) specified: This office is recommending a fire safety disapproval be issued." . On May 9, 2046, Licensing Consultant Kara Robinson conducted an unannounced onsite inspection of Berkley Court Ill and interviewed DCW Supervisor Samantha Green due to an allegation that Resident A (M, DOB 08/19/22) fell in the shower and suffered a head injury while being bathed by staff member Tammy Aldridge. Ms. Green stated that she was in the facility Berkley Court I! when the incident occurred and rushed over to Berkley Court Ill after hearing an emergency announcement over the public address system for her to “come to Building III stat." Upon her arrival Resident A's head was wrapped in a "bloody" towel. Resident A was transported to St. Mary Mercy Hospital via ambulance where he received 3 to 4 stitches and was discharged back to the facility the following day. }. On or about May 9, 2016, Ms. Robinson interviewed Ms. Aldridge who confirmed that she showered Resident A alone when he fell and injured his head. Ms. Aldridge blamed the fall on her lack of training and stated "I didn't know" to use a shower chair with a back or that another staff member should have assisted her. On May 10, 2018, Ms. Robinson interviewed nursing staff members Shalisa Davis and Gia Lovelace who both reported that Ms. Aldridge did not follow protocol pertaining to showering residents. Ms. Davis and Ms. Lovelace both confirmed that Ms. Aldridge mistakenly used a shower chair without a backsupport that helps to prevent falls like the one Resident A suffered. When Ms, Robinson requested to review the incident report of Resident A, Resident B (F, DOB 03/08/44) and Resident C (M, DOB 03/06/16) Ms, Davis and Ms. Lovelace stated that they were instructed by their previous Administrator, Alissa Gash, to not complete incident reports. Ms, Robinson spoke with Licensing Consultant Edith Richardson who confirmed that she did not receive an incident report when Resident A fell and was hospitalized on May 4, 2016. On May 13, 2016, Ms. Robinson made a visit to the facility Berkley Court | to review employee records. Ms. Robinson was assisted by the office manager Joselyn Love. Ms. Robinson reviewed the employee files for Ms. Aldridge, Med Tech April Guiles and direct care worker Luvonia Powers. Upon review of the employee files Ms. Robinson determined the following: a. Ms. Aldridge's date of hire is documented as February 13, 2016, she resigned on May 16, 2016, but had no proof of completion of required in-service training in her file; b. Ms, Powers' date of hire is documented as December 30, 2016, but only had documented training for CPR and First Aid but had no proof of completion of required in-service training in her file, Additionally, her tuberculosis test was not completed until April 1, 2016, three months after she was hired c. Ms. Guiles’ date of hire is January 27, 2016, and she is responsible for administering medication but she has no verification of completion ofmedication administration training, no proof of tuberculosis testing an no proof of required in-service training. During a follow-up interview with Ms. Aldridge she stated to Ms. Robinson "! don't have basic First Aid or CPR training." She stated that the Management ‘Team would agree to schedule training but they never followed through. She did on-the-job training for one day and then assumed her job duties. COUNT! The conduet of Licensee, as set forth in paragraphs 8(b) & 8(c) above, evidences a willful and substantial violation of: R 400.15205 Health of a licensee, direct care staff, administrator, other employees, those volunteers under the direction of the licensee, and members of the household. (8) A licensee shall obtain written evidence, which shall be available for department review, that each direct care staff, other employees, and members of the household have been tested for communicable tuberculosis and that if the disease is present, appropriate precautions shall be taken as required by state law. Current testing shall be obtained before an individual's employment, assumption of duties, or occupancy in the home. The results of subsequent testing shall be verified every 3 years thereafter or more frequently if necessary. {Note: By this reference paragraph 3 is incorporated into this count for the purpose of demonstrating a willful and substantial violation of the above rule.) COUNT II The conduct of Licensee, as set forth in paragraph 8(a), 8(b) & 8(c) above, evidences a willful and substantial violation of R 400,15204 Direct care staff; qualifications and training. (3) A licensee or administrator shall provide in-servicetraining or make training available through other sources to direct care staff. Direct care staff shall be competent before performing assigned tasks, which shall include being competent in alllof the following areas: (@) Reporting requirements. (b) First aid. (c) Cardiopulmonary resuscitation. () Personal care, supervision, and protection. () Resident rights. () Safety and fire prevention. (9) Prevention and containment of communicable diseases, (Note: By this reference paragraph 3 is incorporated into this count for the purpose of demonstrating a willful and substantial violation of the above rule] COUNT Ill The conduct of Licensee, as set forth in paragraph 4 above, evidences a willful and substantial violation of: R 400.15403 Maintenance of premises. (1) A home shall be constructed, arranged, and maintained to provide adequately for the health, safety, and well-being of occupants, [Note: By this reference paragraph 3 is incorporated into this count for the purpose of demonstrating a wiliful and substantial violation of the above rule.] COUNT IV The conduct of Licensee, as set forth in paragraphs 5, 6 & 7 above, evidences a wilful and substantial violation of: R 400.15305, Resident protection. (3) A resident shall be treated with dignity and his or her personal needs, including protection and safety, shall be attended to at all times in accordance with the provisions of the act.COUNT V The conduct of Licensee, as set forth in paragraph 7 above, evidences a willful and substantial violation of: R 400.15311 Investigation and reporting of incidents, accidents, illnesses, absences, and death. (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: (a) The death of a resident. (b) Any accident or illness that requires hospitalization. () _ Incidents that involve any of the following: () Displays of serious hostility. (ii) Hospitalization. Gi) Attempts at self-inflicted harm or harm to others. (iv) Instances of destruction to property, () _ 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. COUNT VI The conduct of Licensee, as set forth in paragraph 8(c) above, evidences a willful and substantial violation of: R 400.15312 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: (a) Be trained in the proper handling and administration of medication.DUE TO THE serious nature of the above violations and the potential risk they represents to vulnerable adults in Licensee's care, emergency action is required. Therefore the provision of MCL 24.292 of the Administrative Procedures Act of 1969, as amended, is invoked. Licensee is hereby notified that the license to operate an adult foster care large group home is summarily suspended. EFFECTIVE 6:00 PM, on May 25, 2016, Licensee is ordered not to operate an adult foster care large group home at 32406 W. Seven Mile Rd., Livonia, Ml 48152 or at any other location or address. Licensee is not to receive adults for care after that time or date. Licensee is responsible for informing case managers or guardians of adults in care that the license has been suspended and that Licensee can no longer provide care. HOWEVER, BECAUSE THE Department has summarily suspended the license, an administrative hearing will be promptly scheduled before an administrative law judge. Licensee MUST NOTIFY the Michigan Administrative Hearings System (MAHS) in writing within five calendar days after receipt of this Notice if Licensee wishes to appeal the summary suspension and attend the administrative hearing. The written request must be submitted via MAIL or FAX to: Michigan Administrative Hearings System 611 West Ottawa Street, 2"! Floor P.O. Box 30695 Lansing, Michigan 48909 Phone: 517-335-2484 FAX: 517-335-6088MCL 24.272 of the Administrative Procedures Act of 1969 permits the Department to proceed with the hearing even if Licensee does not appear. Licensee may be represented by an attorney at the hearing at his or her own expense, DATED: 515 Mo Adult Foster Care and Camps Licensing Division Bureau of Community and Health Systems ‘This is the last and final page of the ORDER OF SUMMARY SUSPENSION AND NOTICE OF INTENT in the matter of Surinder Chandok, Licensee Designee, AL 820282884, consisting of # pages, this page included. JNHSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS. BUREAU OF COMMUNITY AND HEALTH SYSTEMS In the matter of License #: AL820282884 SIR # 2016A0121032 Berkley Court of Livonia LLC DBA Ashley Court Surinder Chandok, Licensee Designee Berkley Court It PROOF OF SERVICE The undersigned certifies that a copy of the Order of Summary Suspension and Notice of Intent was personally served upon the person below on: ia eaeeee cece eee eee EEE Date Time Place Surinder Chandok, Licensee Designee Adult Foster Care and Camps Licensing Division Bureau of Community and Health Systems