11 Reports
Inspection Report — Jan 8, 2026
Renewal
Date: Jan 8, 2026
Visit Reason
Renewal inspection of the adult foster care family home license.
Findings
The home was found in non-compliance with 3 rules; a written corrective action plan was required before the license is renewed.
Deficiencies (3)
R 325.1953 Menus: The posted menu did not include a therapeutic or special diet for the current week.
R 325.1964 Interiors: Continuous exhaust was not functioning in the bathrooms located in apartment numbers 805, 814, 815, 505, 501, 319, 311, 306, 413, 414, and 406.
R 325.1970 Water supply systems: The water in residents’ rooms was not at the range of 105 to 120 degrees Fahrenheit; for example, water in room 319 was tempered at 124.3, room 317 was 121.1, and room 306 was 124.9.
Report Facts
Corrective action plan due: 15
Inspection Report — Oct 4, 2024
Date: Oct 4, 2024
Visit Reason
Addendum purpose: convert 8 assisted living beds into 4 memory care beds and adjust bed counts in specified rooms, resulting in a net decrease of 7 beds and total licensed capacity of 129.
Findings
The addendum approved the relocation of locking doors and bed reconfiguration to increase memory care beds from 32 to 33 and decrease assisted living beds to 96, with a total licensed capacity of 129 beds.
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Memory care beds increase: 1
Assisted living beds decrease: 8
Inspection Report — Jul 24, 2024
Renewal
Date: Jul 24, 2024
Visit Reason
License renewal notice; no inspection report attached. Administrative review without an on-site visit.
Findings
The facility was found in substantial compliance with the public health code and administrative rules regulating homes for the aged. The license has been renewed.
Report Facts
License length: 12
Inspection Report — Mar 13, 2024
Complaint Investigation
Date: Mar 13, 2024
Visit Reason
Investigation of a complaint received on 2024-03-13 about medication administration, personal care, and staff conduct.
Complaint Details
Residents did not receive their medications on time: established. Residents lacked regular showers and were not bathed and cleaned after being soiled: established. Staff handled residents in a “rough manor”: not established.
Findings
Two rule violations were established regarding medication administration and personal care. The allegation of rough handling of residents was not substantiated.
Deficiencies (2)
R 325.1932 Resident medications: medications were not always administered as prescribed by the licensed healthcare professional and within the facility’s guidelines.
R 325.1933 Personal care of residents: some shower records were left blank, making it unconfirmed if showers were received as required.
Report Facts
Corrective action plan due: 15
Inspection Report — Feb 22, 2024
Renewal
Date: Feb 22, 2024
Visit Reason
License renewal notice; no inspection report attached. Administrative review without an on-site visit.
Findings
The facility was found in substantial compliance with the public health code and administrative rules regulating home for the aged facilities; the license has been renewed.
Inspection Report — Oct 6, 2023
Complaint Investigation
Date: Oct 6, 2023
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Investigation of a complaint received on 2023-09-18 about resident care, staffing, medication administration, and cleanliness.
Complaint Details
Residents not getting showers on time: not established. Facility understaffed: not established. Medication errors: established. Facility not clean: not established.
Findings
One rule violation was established regarding medication administration errors; other allegations were not substantiated.
Deficiencies (1)
R 325.1932 Resident medications: medication was not always given as prescribed to Residents B, C, D, and E as shown in their MARs.
Report Facts
Corrective action plan due: 15
Inspection Report — Oct 5, 2023
Renewal
Date: Oct 5, 2023
Visit Reason
Renewal inspection of the adult foster care family home license.
Findings
The home was found in non-compliance with 5 rules; a written corrective action plan was required before the license is renewed.
Deficiencies (5)
R 325.1922 (5) A home shall update each resident's service plan at least annually or if there is a significant change in the resident's care needs. Changes shall be communicated to the resident and his or her authorized representative, if any. Five of seven residents’ service plans were not updated.
R 325.1924 (1) A home for the aged must implement and maintain a quality review program consistent with section 20175(8) of the act, MCL 333.20175, and the professional review function. The administrator stated that she has not implemented the quality review program.
R 325.1932 (3) Staff who supervise medication administration must complete an individual medication log and notify licensed health care professionals when medication is refused. Resident A and Resident B had refusals in September with no physician notification or service plan updates.
R 325.1964 (9)(b) Ventilation shall be provided throughout the facility. Residents’ bathing/toilet facilities in multiple rooms and the janitor closet lacked adequate and discernable air flow.
R 325.1976 (13) A multi-use utensil used in food storage, preparation, transport, or serving shall be thoroughly cleaned and sanitized after each use and protected from contamination. Flour container had flour spread on top and the scooper was laying on top without covering.
Report Facts
Corrective action plan due: 15
Inspection Report — May 12, 2023
Complaint Investigation
Date: May 12, 2023
Visit Reason
Investigation of a complaint received on 2023-05-11 about protection, care, abuse, staffing, food temperature, and cleaning.
Complaint Details
The facility lacked an organized program for protection, care, and abuse: established. The memory care unit lacked two staff members on duty: not established. The food was cold: established. The facility lacked cleaning: not established. Additional findings: not established.
Findings
Two rule violations were established related to lack of an organized program for protection, care, and abuse, and food safety. Other allegations were not substantiated.
Deficiencies (2)
R 325.1921 Governing bodies, administrators, and supervisors: the facility lacked an organized program to ensure safe exit for memory care residents and personal care consistent with admission contract and policies.
R 325.1976 Kitchen and dietary: kitchen staff failed to document internal food temperatures, making it uncertain that food served was safe for consumption.
Report Facts
Corrective action plan due: 15
Inspection Report — Feb 2, 2023
Date: Feb 2, 2023
Visit Reason
Addendum purpose: convert 14 existing beds to memory care unit and convert one room to a day room for added space.
Findings
The facility was approved to convert 14 existing beds to a memory care unit and convert one room to a day room, resulting in a total licensed capacity of 136 beds.
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Inspection Report — Sep 28, 2022
Date: Sep 28, 2022
Visit Reason
Increase capacity from 120 to 138 beds by converting 14 additional beds to a memory care unit and converting one room to a day room, per licensee request.
Findings
The facility was approved to convert 14 additional beds to a memory care unit and convert one room to a day room. The total capacity remains 138 beds.
Report Facts
Inspection Report — Feb 2, 2022
Date: Feb 2, 2022
Visit Reason
Increase capacity from 0 to 18 memory care beds by converting existing beds to a memory care unit.
Findings
The facility was approved to convert 18 beds of the 138 beds to be designated as the memory care unit. There were no deficiencies noted related to the fire alarm project or physical environment.
Report Facts
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