View the Enclosed Documentation for Accuracy and Contact Me with Any Questions

STATE OF MICHIGAN GRETCHEN WHITMER DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS ORLENE HAWKS GOVERNOR DIRECTOR LANSING

March 19, 2021

Rose Bouck 12700 Lincoln Lake Rd Gowen, MI 49326

RE: License #: AF410395782 Investigation #: 2021A0357012 Country Acres

Dear Ms. Bouck:

Attached is the Special Investigation Report for the above referenced facility. Due to the violations identified in the report, a written corrective action plan was required. However, on 03/19/2021 you submitted a statement indicating that in lieu of a corrective action plan, you have decided to discontinue providing adult foster care and requested that your license be closed.

Your written request to close your license along with the understanding that you are no longer providing adult foster care services has been accepted in lieu of a Corrective Action Plan. As a result your license will be closed effective on 03/19/2021.

Please review the enclosed documentation for accuracy and contact me with any questions.

Sincerely,

Arlene B. Smith, MSW, Licensing Consultant Bureau of Community and Health Systems, Unit 13, 7th Floor 350 Ottawa, N.W., Grand Rapids, MI 49503 (616) 916-4213

enclosure

611 W. OTTAWA  P.O. BOX 30664  LANSING, MICHIGAN 48909 www.michigan.gov/lara  517-335-1980 MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF COMMUNITY AND HEALTH SYSTEMS SPECIAL INVESTIGATION REPORT This report contains quoted profanity.

I. IDENTIFYING INFORMATION

License #: AF410395782

Investigation #: 2021A0357012

Complaint Receipt Date: 01/04/2021

Investigation Initiation Date: 01/04/2021

Report Due Date: 03/05/2021

Licensee Name: Rose Bouck

Licensee Address: 12700 Lincoln Lake Rd, Gowen, MI 49326

Licensee Telephone #: (616) 302-5702

Name of Facility: Country Acres

Facility Address: 12700 Lincoln Lake Rd, Gowen, MI 49326

Facility Telephone #: (616) 712-6002

Original Issuance Date: 11/01/2018

License Status: REGULAR

Effective Date: 05/01/2019

Expiration Date: 04/30/2021

Capacity: 6

Program Type: PHYSICALLY HANDICAPPED, TRUMATICALLY BRAIN INJURED, DEVELOPMENTALLY DISABLED, MENTALLY ILL, AGED, ALZHEIMERS

1 II. ALLEGATION(S) Violation Established? There is yelling and swearing in front of residents. Yes Light bulbs in resident rooms are removed at night to prevent Yes residents from staying up too late. Resident A was locked in her bedroom. Yes The home was found with an excessive amount of unused resident medications. Ms. Wagner yells and screams at Resident E. No Ms. Bouck told Resident E he was not safe in the home, bitches at No him, tells Resident B to shut up, and makes him stay in his room.

III. METHODOLOGY

01/04/2021 Special Investigation Intake 2021A0357012

01/04/2021 Special Investigation Initiated - Telephone to Recipient Rights, Edward Wilson, network 180, Kent County

01/04/2021 Contact - Telephone call received From Rose Bouck, the Licensee, with a long history between Fran Wagner and their family members.

01/04/2021 Contact- APS Referral to Kent County.

01/05/2021 Contact - Telephone call made With Rose Bouck, the Licensee.

01/05/2021 Contact - Telephone call made With Fran Wagner, the Responsible Person/ property owner.

02/15/2021 Contact – Telephone call received\ From Behavioralist Cora.

01/23/2021 Contact - Document Received Received a video from Rose Bouck.

01/23/2021 Contact - Telephone call received From Rose Bouck

01/23/2021 Contact - Telephone call received From Rose Bouck.

01/26/2021 Contact - Document Received

2 Rose Bouck faxed me documents from Resident A's file including, face sheet, IPOS, Resident Care Agreement, Health Care Appraisal, Sparks Behavioral Services L.L.C., Behavioral Treatment Plan with revision, (Baseline Data): SIB (head hitting), Rectal Digging, Skin Picking, Drink swiping, Object swiping, Resident A is non-verbal.

01/27/2021 Contact - Document Received Received video

01/29/2021 Contact - Telephone call received From Rose Bouck.

01/29/2021 Contact - Telephone call made Telephone interview with Resident E.

02/02/2021 Contact - Document Received Received a text message from Rose Bouck.

02/02/2021 Contact - Telephone call made Conducted interviews with staff, Nicole Brzak and Sherry Bartlett.

02/04/2021 Contact - Telephone call made To staff Brittanie Rogers, Ms. Wagner’s niece.

02/05/2021 Contact - Telephone call received Received telephone from Rose Bouck with more information.

02/05/2021 Contact - Telephone call received From Rose Bouck.

02/09/2021 Contact - Telephone call received From Bob Patterson, Recipient Rights, network 180.

02/09/2021 Contact - Telephone call made To Resident A's Behavioral Specialist, Cora Santman.

02/10/2021 Contact - Telephone call made Telephone call made to Sharon Kosters, Public Guardian for Resident A.

02/10/2021 Contact - Document Received Sharon Kosters

3 02/11/2021 Contact - Face to Face Interview with Frances Wagner concerning the complaints at Country Acres.

02/16/2021 Contact - Document Received Rose Bouck

02/16/2021 Contact - Document Received Received pictures of resident's medication cards and bottles from Angela Loiselle, Recipient Rights Director, from Montcalm Care Network.

02/16/2021 Contact document received from Michelle Richardson Sent four more Recipient Rights Complaints.

02/16/2021 Contact - Telephone call made To Recipient Rights, Edward Wilson and Michelle Richardson and discussed the complaints.

02/17/2021 Inspection Completed On-site I met Edward Wilson at the home and we interviewed Ms. Bouck, and Resident A.

02/17/2021 Inspection Completed On-site Interviewed Rose Bouck. A Detective came from the Kent County Sheriff's Office, Detective Stanton.

02/17/2021 Contact - Document Received Edward Wilson provided me with a copy of the complaint for Resident's medications that were stored in the home.

02/18/2021 Contact - Telephone call received From Rose Bouck.

02/19/2021 Inspection Completed On-site I met with Rose Bouck.

02/23/2021 Contact - Document Received Email received from Tae Naumes, Contract Manager for network 180, terminating Ms. Bouck’s CLS contract on 02/24/2021.

02/24/2021 Contact - Document Received Received email from Drew Blackall, APS, Kent County

02/25/2021 Contact - Document Received

4 Drew Backall sent an email that Resident A has moved into a new home.

03/03/2021 Contact – Telephone call made to L T C Pharmacy and interviewed Matthew Aldrich.

O3/03/2021 Contact – Email received with the MAR’s of Resident A, B, C, D, and E. I reviewed the MAR’s. 03/08/2021 Contact – Telephone call made to Michelle Richardson, Recipient Rights, network 180.

03/11/2021 Contact – Telephone call made to Michelle Richardson, Recipient Rights, network 180.

03/17/2021 Contact – Telephone call made to Cora Santman, Behavioral Specialist, Rose Bouck, Licensee and Frances Wagner, Responsible Person.

03/17/2021 Contact – Telephone from Ms. Bouck asking to close her licensee

03/18/2021 Exit Conference conducted by telephone with Ms. Bouck, licensee.

ALLEGATION: There is yelling and swearing in front of residents.

INVESTIGATION: On 01/04/2021, I received a complaint from our Lansing office. The Allegations read as follows: “Country Acres AFC homes has 5 residents that are vulnerable adults. Fran Wagner, she removes the light bulbs at night as she states the residents stay up too late. Fran yells and swears in front of residents.”

Upon interviewing Ms. Bouck on 01/05/2021, she explained that relationship between her and Ms. Frances Wagner had significantly deteriorated to the point that their conversations had become less than civil and included Ms. Wagner yelling, and swearing at her in front of residents. It is noted that Ms. Wagner is the property owner and designated “responsible person” of this facility and resides with her husband on the lower level.

On 01/04/2021 I received a telephone call from Danial Wagner, who explained that he had received a phone call from his wife, Ms. Bouck who informed him that the home’s owner (Fran Wagner), was yelling, swearing and verbally abusing Ms. Bouck in front of residents and he requested that I go to the home. I told him I could not go and if he thought that residents were in danger of any kind, he should call the police.

On 01/05/2021, I spoke by telephone with Ms. Bouck and she explained that Ms. Wagner had come to the home after she had learned that Ms. Bouck was planning to leave the AFC home and seek other employment. She said Ms. Wagner “freaked

5 out,” and started yelling and swearing at her in the kitchen while residents were in the living room. She reported that Ms. Wagner became loud and was verbally abusive to her and called her a “little bitch and a liar.” Ms. Bouck acknowledged that she became upset and told Ms. Wagner; “Your shit needs to end. I’m done with this.” Ms. Bouck stated she called her husband who told her to call the police. Ms. Bouck stated that the police were called, and the Kent County Sheriff’s office sent an officer to the home. Ms. Bouck explained that the officer talked to her alone and to Ms. Wagner alone and he advised them to stay away from each other. Ms. Bouck said that the residents in the living room would not be able to reliably report about the incident due to their disabilities, but that Resident B was sitting in the living room crying while the argument was going on.

On 01/05/2021, I conducted a telephone interview with Mr. Wagner, and he confirmed that he heard part of the verbal exchange between the two women. He said he heard Ms. Wagner used the words, “bitch and liar,” towards Ms. Bouck. He said he went to the home and observed that the residents were in the living room.

On 01/05/2021, I conducted a telephone interview with Ms. Wagner. She acknowledged that she and Ms. Bouck had a heated verbal exchange related to their family members and she was embarrassed to tell me what it was about. She explained that they had a strong disagreement, and it was not a good exchange. She said: “All there is, is drama around Rose. She is a pathological liar. I tried to speak nicely to her. She was yelling and cursing, and I told her to stop lying. I need her out of here. I don’t trust a dam thing about her. She told me to shut the hell up.” I asked Ms. Wagner if she had used any swear words and she acknowledged that she may have. She confirmed that the police came to the home and interviewed her and Ms. Bouck separately and the officer advised them to stay apart.

On 02/17/2021, I was at the AFC home for an inspection as part of this investigation. I observed that that the dining room is adjacent to the kitchen and the living room is adjacent to the dining room so any argument between people in the kitchen would have been heard by the residents in the dining or living room.

On 03/18/2021, I conducted a telephone exit conference with Ms. Bouck, Licensee and she agreed with my findings.

APPLICABLE RULE R 400.1409 Resident rights; licensee responsibility.

(1) Upon a resident's admission to the home, the licensee shall inform and explain to the resident or the resident's designated representative all of the following resident rights: (o) The right to be treated with consideration and respect, with due recognition of personal dignity, individuality, and the need for privacy.

6 ANALYSIS: Both Ms. Wagner and Ms. Bouck acknowledged that they had a heated and loud discussion with each other and they used swear words while residents were in the living room.

There is a preponderance of evidence that the residents were not treated with consideration, dignity or respect when they heard Ms. Wagner and Ms. Bouck arguing loudly and swearing at each other.

CONCLUSION: VIOLATION ESTABLISHED

ALLEGATION: Light bulbs in resident rooms are removed at night to prevent residents from staying up too late.

On 01/05/2021, I conducted an interview with Ms. Bouck concerning the allegation that light bulbs in resident’s rooms are removed at night. Ms. Bouck explained that she normally works the first shift 8:00 A. M. to 4:00 P.M. and then her second shift staff work from 4:00 P.M. to 9:00 P.M. She reported that her two staff on second shift, Nicole Brzak, and Sherry Bartlett, had reported to her that Resident C was found crying in his dark bedroom because his lights did not come on when the switch was turned on. She explained that Resident C is afraid of the dark and he can’t go to sleep unless the lights are on and that this has been the case for over ten years. Ms. Bouck also said that they reported the lights were out in Resident A’s bedroom. She said she checked the lights and confirmed they did not come on. She said she checked the bulbs, and they were in place but unscrewed to the point that there was not electrical current going into them. She said she found light bulbs missing. Ms. Bouck stated that she asked Ms. Wagner about the lights and Ms. Wagner told her that Resident C keeps his lights on all night, and this keeps everyone else up all night. Ms. Bouck stated that this statement by Ms. Wagner was not true. Ms. Bouck reported that this went on for some time at least a month and still Ms. Wagner had not corrected the lights, so she asked her again and Ms. Wagner reported that the bulbs were disabled because she was in the process of having ceiling fans installed, which were not installed until much later. She stated that Resident C no longer resides in the home.

On 02/02/2021, I conducted an interview with staff Nicole Brzak. She stated that she worked the second shift from 11/03/2020 until 12/15/2020. She said she worked Wednesday’s and Thursdays and every other weekend Saturdays from the AM to until Sunday night. She reported that Ms. Wagner and her husband lived on the lower level of the home. I asked her about the lights, and she stated that she would go to Resident C’s bedroom to let him know it was dinner time and she would turn his light switch on and the lights would not come on. She said he was crying because he was afraid of the dark. She stated that she noticed that the globes covering the lights were missing in Resident A and Resident C’s bedrooms. She reported that she checked the bulbs and found them to be unscrewed and therefore

7 they did not work. She said she screwed the bulbs back in. She said she reported her findings to Ms. Bouck and that Ms. Bouck told her she thought Ms. Wagner was unscrewing the bulbs.

On 02/02/2021 I conducted a telephone interview with staff, Sherry Bartlett. She stated that she worked the second shift at Country Acres, and she reported that the light bulbs in Resident A’s bedroom did not work when she turned on the light switch. She said that she had to use the flashlight on her phone to get Resident A ready for bed many times. She said the Resident C was independent and she did not have help him therefore, she rarely went to his room at nighttime. She said one time she remembered that she went to his room to interact with him and she turned on the light switch and the lights did not come on. She said this went on for at least three months. Ms. Bartlett stated that Ms. Wagner was aware of the problem, but she kept telling them that they were putting up fans in their rooms. She also explained that neither Resident A nor Resident C could speak so they would not be able to be interviewed.

On 02/11/202, I conducted a face-to-face interview with Ms. Wagner. She stated that she did not unscrew any light bulbs in any resident bedrooms and that if they were burned out there was a full shelf of new bulbs and all they had to do was put new bulbs in. She stated that they were putting in new ceiling fans and it took some time for that to occur.

On 02/12/2021, I spoke with Bob Patterson, Recipient Rights, network 180 and he said he had interviewed Ms. Wagner on that same day. He reported that Ms. Wagner stated that there might have been times the bulbs were not functional when the ceiling fans were being installed, but she denied routinely unscrewing or disabling them as alleged. Ms. Wagner reasoned that if any of the staff found that the bulbs were not working, they could have easily replaced them with new ones that were in the home.

On 03/18/2021, I conducted an exit conference by telephone with the Licensee, Ms. Bouck and she agreed with my findings.

APPLICABLE RULE R 400.1409 Resident rights; licensee responsibility.

8 ANALYSIS: Ms. Bouck, Ms. Brzak and Ms. Bartlette all reported that the light switch in Resident A and Resident C’s bedroom would not turn the lights on. Both Ms. Bouck and Ms. Brzak found the light bulbs had been loosened.

Ms. Wagner denied that she had unscrewed the light bulbs in the resident’s bedrooms but there might have been times the bulbs were not functional when the ceiling fans were being installed.

There is a preponderance of evidence that Resident A and Resident C were not treated with consideration, dignity or respect when their lights in their bedrooms did not work.

CONCLUSION: VIOLATION ESTABLISHED

ALLEGATION: Resident A was locked in her bedroom.

INVESTIGATION: During my telephone interviews with Ms. Bouck, she reported to me that the door handle to Resident A’s bedroom had previously been turned around, so the lock was on the outside of the door, which was then locked, and Resident A was locked inside of her bedroom during her nighttime hours. She said she had staff working on 3rd shift and therefore Resident A’s bedroom door did not need to be locked. She denied that she personally had locked Resident A’s door.

On 01/23/2021, Ms. Bouck sent me a video of the door handle to Resident A’s bedroom which was turned around so the lock, originally required on the inside for non-locking-against-egress, was on the outside of the door and it was locked so Resident A could not leave her bedroom.

On 01/27/2021, Ms. Bouck sent me a second video of Resident A’s door handle the same way and she found Resident A locked in her bedroom. Attached to the video was a typed text message that read: ‘I came in early morning just to see if she (Ms. Wagner) turns it around at night after staff leaves…and she does. She (Ms. Wagner) up with Bob (Mr. Goes) and he had a drill to turn it the right way before I get here (normally at 7:30 or 8) and was caught off guard to see us already here. She waited around trying to get a opportunity to fix it but never got it. I caught it on video the handle being the wrong way.’

On 02/02/2021, I conducted a telephone interview with staff, Nicole Brzak. She stated that when she worked at the AFC home, she noticed that the doorknob to Resident A’s bedroom was on backwards. She said the lock was on the outside of the door instead of the inside of the door. She reported that Resident E told her that she needed to lock Resident A’s door at night so that Resident A does not come out of her room. She stated that Ms. Bouck never told her that Resident A was to be

9 locked in her bedroom during the night. Ms. Brzak said she reported this to Ms. Bouck and Ms. Bouck told her that Ms. Wagner was locking Resident A’s door. She said she asked Ms. Wagner about it too, and Ms. Wagner told her the door was too be locked after Resident A went to bed at night to prevent her from coming out and getting into other resident’s bedrooms and stealing things. She stated that Ms. Wagner changed the lock back and forth. She stated that when she worked through the 3rd shift., she did not lock Resident A in her bedroom and once she was asleep Resident A stayed in her bedroom. Ms. Brzak stated that there are no sleeping places for staff on the upper level of the home or the main level of the home where the residents are located because the bed in the office was removed by Ms. Wagner. She said she did not think there were any staff working on the 3rd shift during the weekdays.

On 02/02/2021, I conducted a telephone interview with staff, Sherry Bartlett. She explained that Ms. Wagner had instructed her and Ms. Brzak to lock Resident A’s bedroom door at the end of the 2nd. shift. She explained that when her shift was over if Ms. Wagner did not come upstairs to the main level that she would lock the door. She explained that one time she saw Ms. Wagner changing the doorknob around and she asked Ms. Bartlett to help her with the screw so all she did was hold the screw so Ms. Wagner could screw it into place. She said she was told to lock the door for safety reasons by Ms. Wagner. She stated that she never changed the doorknob around to Resident A’s bedroom door. She explained that Resident A came from Country Meadows and that she worked in the home and she knew they were locking Resident A in her bedroom at night because she saw the baby lock on the door. She stated that Resident A learned to take the baby lock off the door. She explained when Resident A came to Country Acres, the staff from Country Meadows had written out a list of all of her needs. She explained that the list is no longer around. When Ms. Bartlett worked the night shift, she said she never heard Resident A get up.

On 02/04/2021, I conducted a telephone interview with staff Brittanie Rogers. She said she had only worked in the home for a few months. She said that when she started working on the second shift, she was trained by Ms. Bouck. She stated the lock was turned around and Ms. Bouck instructed her to lock the bedroom door at night to prevent Resident A from coming out of her room and getting into things. She thought all the staff on second shift were doing the same thing for Resident A’s safety. She assumed that this was all legal and so she did not question it and until recently she had been locking Resident A’s bedroom door when she left her 2nd. shift.

On 02/09/2021, I conducted a telephone interview with Resident A’s Behavioral Specialist, Cora Santman, from Sparks Behavioral Services L.L.C. She stated that Resident A’s Behavioral Treatment Plan, dated 08/09/2020, included 20 pages with revision on 09/21/2020 and 10/23/2020. She stated that they had started with Baseline Data that included Resident A’s Self Abusive Behaviors (SIB) (head hitting), Rectal Digging, Skin Picking, Drink swiping, and Object swiping. She

10 stated that since Resident A began receiving care from Ms. Bouck and her staff that Resident A had substantially improved. She said that she is now using simple signs to express some of her needs. She stated that Ms. Bouck had called her to request that Resident A’s Behavioral Treatment Plan allow the bedroom door to be locked at nighttime. Ms. Santman stated that this would never happen because that would mean “seclusion,” and no resident can ever be in seclusion. She said she explained this to Ms. Bouck. She said that would violate Resident A’s recipient rights. She also stated that Resident A needs awake staff on 3rd. shift.

On 02/10/2021, I conducted a telephone interview with Sharon Kosters, Public Guardian for Resident A. She explained that Frances Wagner had asked her to write a permission slip to lock Resident A's bedroom door at night because she was getting into the water, without thicket, and running into another resident’s room that has a tube feeding and Resident A might pull the tube feeding out. She said the request was all about safety for Resident A as well as the other residents. She said she did not want any resident to suffer because of Resident A, therefore she explained that she wrote a statement authorizing staff to lock Resident A’s bedroom door. Ms. Kosters stated she did not know it was wrong to lock a resident in her bedroom at sleeping times. She stated that she would write another statement that would rescind the first letter. She stated that she would deliver the new letter to the AFC home and she would explain to them that Resident A could not be locked in her bedroom.

On 02/10/2021, Ms. Kosters faxed me her written permission letter dated 01/18/2021 at 5:27 P.M. The letter read as follows: “To Whom it may concern- I give my permission for Country Acres, Country Meadows, or Northern Pathways to lock the bedroom door on (Resident A’s) room for her own safety as well as her others during the sleeping hours. She will get up at night and will run into the bathroom and drink water which makes her aspirate, and/or she runs into other residents’ rooms, wakes them up, takes whatever she can grab until staff get to her. Her roommate across the hall from her has a feeding tube, (Resident A) will run to the tube and start pulling on it before staff can get to her. (Resident A) has been prescribed a sleep aid but currently it is not working. Until other measures can be taken to insure her and others safety, I give my permission to lock her door. Sharon Kosters, guardian for (Resident A).”

On 02/10/2021, I received another letter from Ms. Kosters dated 02/10/2021. This letter read as follows: “This note follows our phone call of today. (Resident A) has improved and no longer requires any type of restraints during the overnight hours that cannot be handled by the awake staff. This supersedes the January 18 email by guardian Sharon Kosters.”

On 02/11/2021, I conducted an interview with Ms. Wagner. She said that Resident A would go into all the other residents’ rooms and take things every five to ten minutes. She stated that all staff did it but she was not locked in her room every night. She would run to the kitchen and get cups from the cupboard and then get water from the

11 refrigerator and she did it very quickly. Ms. Wagner said she was concerned for Resident D because she had a feeding tube and Ms. Wagner was afraid that Resident A would pull it out. Ms. Wagner acknowledged that she locked Resident A in her bedroom but stated she did it for Resident A and the other residents’ safety. Ms. Wagner stated she asked Resident A’s guardian for permission to lock Resident A in her room and she gave verbal permission. Ms. Wagner said she contacted Resident A’s physician and asked him to order CBD gummies for Resident A to be able to sleep at night and he did, and she reported that Resident A is now sleeping better.

On 02/17/2021, I met Mr. Edward Wilson, Director of Recipient Rights for network 180 at the AFC home. We observed the lock on Resident A’s door and Mr. Wilson pointed out the groves on the metal of the doorhandle were evident that the screws had been taken in and out. We interviewed Ms. Bouck and she stated that Resident A came from Country Meadows with a “baby-lock for her door.” Ms. Bouck stated she did put the baby lock on Resident A’s door at nighttime, but Resident A easily removed it and since it was plastic, it broke.

On 03/17/2021, I re-interviewed Ms. Bouck by telephone about the lock on Resident A’s door and I asked her to start at the beginning. She explained that when Resident A arrived in her AFC home she came with a baby lock for her door. She said when they put the baby lock on Resident A’s door, Resident A could remove it herself. Then the plastic baby lock broke. Ms. Bouck stated she had staff on 3rd shift so they could meet Resident A’s needs if she got up during the night. She stated further that Ms. Wagner had moved into the lower level of the home and she said they did not need a 3rd, shift staff because she was there in the home. Ms. Bouck said she questioned Ms. Wagner about the lock on Resident A’s bedroom door because Resident A had lived in Ms. Wagner’s licensed family home, Country Meadows for years so she would have known her well. Ms. Bouck stated that Ms. Wagner told her that the lock on the door was in Resident A’s plans, PCP and in her behavioral treatment plan. Ms. Bouck asked to see Resident A’s plans, but Ms. Wagner did not provide them. Ms. Bouck stated that she heard from her staff that Resident A’s doorhandle, with the lock had been turned around so the lock was on the outside of the door and when the lock was pressed in, the door was locked from the outside and Resident A could not leave her bedroom. She said she called Resident A’s Behavioral Specialist, Cora Santman, to ask the door locking to be put in Resident A’s plans. She said Ms. Santman explained to her it was not in Resident A’s plan nor would it ever be. Ms. Bouck stated that Ms. Santman had educated her on resident’s rights and what seclusion was about. Ms. Bouck stated that she realized that she would be responsible for Resident A’s bedroom door being locked. She acknowledged that it was her responsibility for the lock on the door and in the beginning she had used the baby lock on the door. She also acknowledged that her staff had informed her of the lock was being changed at night. She also reported that she had come in early to work to find the door locked. Therefore, she was aware that Resident A was locked in her bedroom.

12 On 03/18/2021, I conducted a telephone exit conference with the Licensee, Ms. Bouck and she agreed with my findings.

APPLICABLE RULE R 400.1412 Resident behavior management; prohibitions.

(2) A Licensee, responsible person, or any persons living in the home shall not use any of the following methods of handling a resident for discipline purposes: (c) Confining a resident in an area such as a closet, locked room, box or similar cubicle.

ANALYSIS: The Licensee, Rose Bouck acknowledged that she had locked Resident A in her room with the baby lock and she was aware that staff had locked Resident A in her room.

I received and reviewed two videos showing Resident A’s bedroom door lock was on the out-side of the door so it could be locked from the outside.

Ms. Wagner acknowledged that Resident A’s bedroom door was sometimes locked on third shift for health, safety and protection of the homes’ residents.

Direct care staff Nicole Brzak denied that she had locked Resident A’s bedroom door. Direct care staff, Sherry Bartlett acknowledged that she did lock Resident A’s bedroom door when she left second shift.

Direct Care Staff, Ms. Rogers, reported that Ms. Bouck had trained her and she told her to lock Resident A’s bedroom door.

Ms. Kosters, Resident A’s guardian, confirmed that she had given written permission for staff to lock Resident A’s bedroom door.

Resident A’s Behavioral Specialist, Ms. Santman stated she was contacted by Ms. Bouck and asked to add approval of a door lock to Resident A’s behavior treatment plans, but Ms. Santman refused to do so.

There is a preponderance of evidence that Resident A’s doorknob, was turned around so the lock was on the outside of the door which was then locked by staff so Resident A was confined in her bedroom during sleep hours.

13 CONCLUSION: VIOLATION ESTABLISHED

ALLEGATION: The home was found with an excessive amount of unused resident medications.

INVESTIGATION: On 02/11/2021 at the end my interview with Ms. Wagner concerning the allegations at Country Acres, Ms. Wagner showed me some pictures on her phone. She said the pictures were of the excess medications that Ms. Bouk had for the residents. She stated that she was not going to make an allegation about the medications, but she wanted me to know.

On 02/15/2021, I received a telephone call from Angela Loiselle, Director of Recipient Rights at Montcalm Care Network. She said she received information of the over-supply medication and was going to the home to check on the residents’ medications.

On 02/16/2021, Ms. Loiselle sent me 26 pictures of residents’ medication cards and bottles that she had found stored in the home. She laid out each resident’s medication punch card and took pictures. She also took pictures of Resident E’s bottles of her prescribed liquid Tylenol which counted 19 bottles. (Note: According to Ms. Bartlett, the direct care staff that worked with Ms. Loiselle during this time, did not take the extra punch cards in the lower drawer nor the liquid medications that were in the med cart. Therefore, those medications were not pictured.)

On 02/16/2021, I received an email from Michelle Richardson, Recipient Rights at network 180 with an attachment with four new Recipient Rights complaints. The first one was concerning medications and there were pictures of medications attached. The complaint read as follows: ‘I walked into the office to fax and seen 2 boxes of medications for all residents that had not been given at least 3 to 4 months worth. I was shocked. Rose does not believe in getting [sic]her children vaccinated and thinks that pills and Tylenol are poision [sic] to people. She has told many people this. I honestly don’t think that she was giving residents their prescribed medications. Theres [sic] no way there could have been that many packages of meds left over if residents were getting their prescribed doses. Then I seen in the bottom drawer of the med cart that its full of at least another 2 months worth of meds. (How can this be?) Nobody should ever have that many extra pills. I feel that she has not been giving meds to residents because of her own beliefs…’

On 02/16/2021, Ms. Bouck and I discussed the extra resident medications. She said that she was taught by the previous licensee, Angela Welch, that you keep resident’s medications in the event you need them for the future such as in a snowstorm, and the pharmacy can’t get to you and then you have medications to administer. She stated that Resident D had extensive hospital stays (when the home did not administer her medications) so she knew there would be extra of her medications. I asked her if she ever called the pharmacy to let them know she had

14 extra medications and to hold them until they could use up those medications first. She stated she had not. She said that she destroys medications after they have expired, and she follows the directions of the Federal Drug Administration. She said she recently went through all of the resident’s unused mediations and destroyed all that had reached their expiration date. I asked if she had kept a record of what she had destroyed and she said no. She said that Ms. Bartlett, one of her direct care staff, recently had suggest that they put all the overflow of resident medications in the lower drawer of the medication cart, which Ms. Bouck said she did. She explained that when staff had completed a resident’s medically supplied container or punch card, they just had to reach in the bottom drawer and find that resident’s medication punch card no matter the date of the card and that is what they started using. Ms. Bouck stated that she has always administered resident’s medications as prescribed and so did her staff.

On 02/16/2021, Ms. Bouck sent me a text message saying: “This is the chart I saved, and I go by this when I get rid of my meds.” “Where and How to Dispose of Unused Medicines,” which listed steps one through four.

On 02/17/2021, I met Mr. Wilson at Country Acres home with the Licensee, Ms. Rose Bouck. We observed the residents’ medications in their original containers, which included the cards and liquid medication in bottles, sitting in a box in the office. Mr. Wilson requested Ms. Bouck pull up one of the resident’s MAR (medication administration record) and we observed the staff’s signature. Ms. Bouck stated that she and her staff always do the electronic signature on the MAR for each medication administered. She stared that she has looked at some of the resident’s MARs and found that there were staff’s initials missing on the second shift as well as the first. She also stated that if she is being accused of not administrating resident’s medications and she only works first shift (except on the weekends), this would not explain the empty spaces with no staff’s initials recorded on the second shift as well.

On 02/19/2021, I met Ms. Bouck at the AFC home and she showed me the bottom drawer which was filled with residents’ medication punch cards. I asked her to show me how she uses the bottom drawer. She said when they finish a punch card, they reach into the bottom drawer to find the resident by name and the medication by name and they pull it up to the top drawer and place in order of AM or PM. I observed that the medications in the bottom drawer were not in any order. Therefore, they would pull up any punch card no matter the date. It could be a punch card from November 2020. I asked if the February medications had arrived. She stated they had but they do not arrive on the 1st of the month. She said they arrive on the 10th of the month. She assured me that they were not currently using the punch cards in the bottom drawer since the February medications had arrived. I asked her to remove all the medication punch cards, by resident name, from the drawer since they were not using them and put them into plastic bags. I observed Ms. Bouck then put all of the resident’s medication dated February 2021 in order of resident name and by the AM or PM’s times of administration. She put all of the January’s 2021, resident punch cards and liquid medications in the lowest drawer of

15 the med cart. She put the medications from the lower drawer into the plastic bags and took them to the office where the other medications were located. There were a significant amount of medications. I asked Ms. Bouck why there were so much excess medication and she reported that she knew she had administered the prescribed medications to the residents and so had her staff. She stated she did not know why there were so many medications left over. I then asked Ms. Bouck to pull up one of the resident’s MAR which she did. I asked her to copy the MAR and she explained she could not copy anything nor could she fax anything. As we looked at the MAR and I observed days where there were no staff’s initials. Ms. Bouck produced a calendar and stated that Ms. Wagner and Ms. Rogers worked in the home that day that the signatures were missing. Ms. Bouck reported that Ms. Rogers was currently working and present in the home along with Ms. Wagner. Ms. Bouck invited them in to view the MAR.

While in the home on 02/19/2021 I asked Ms. Wagner and Ms. Rogers to look at the MAR which they did, and Ms. Wagner stated that she did not work that day even though her name was on the calendar. Ms. Bouck and Ms. Wagner argued who’s handwriting was on the calendar. Ms. Wagner stated that she was never trained on how to use the electronic MAR and she did not have a password so she called the Pharmacy and requested blank MAR’s so she could chart her own initials on the MAR’s that she stated she kept to herself. Ms. Bouck and Ms. Wagner proceeded to argue about who worked which days and whether or not Ms. Wagner had been trained on the use of the electronic MAR. In the meantime, Ms. Rogers declared she did not work on that date in question and produced her calendar on her phone saying she was in Paw Paw, MI., and therefore she could not be held responsible for not signing her initials because she was not working. This verbal exchange became futile and I ended the discussion. Ms. Bouck handed me her calendar and gave me permission to look through to see whose name was recoded to work on what day of the month and the shift. Since family homes rules do not require a staff schedule be maintained, I had no way of knowing who actually worked in the home on what shift or what day especially if changes had been made and not changed on the calendar. I did review the calendar for 2020, but it was not helpful to the investigation at this time.

On 02/19/2021, I reviewed all of the medication punch cards including liquids and recorded how many medications of each resident were left over. They were dated back to July 2020 and I reviewed through 12/2020 and there were many. The medications were very disorganized.

I reviewed Resident A’s medication punch cards and found for each of her prescribed medications starting with punch cards dated at 07/22/2020 and each month thereafter there were 16 full punch cards and nine partial punched medical cards remaining.

I reviewed Resident B’s medication punch cards and found for each of her prescribed medications starting with punch cards dated at 07/22/2020, and each

16 month thereafter, there were 34 full medication punch cards and 28 partial medication punch cards remaining.

Resident C had moved out of the AFC home before this investigation.

I reviewed Resident D’s medication punch cards and found for each of her prescribed medications starting with punch cards dated 07/22/2020, and each month thereafter, there were 35 full medication punch cards remaining. There were no partial medication punch cards. Resident D’s prescribed liquid Tylenol left over, including 23 total bottles. She had a PRN (as needed medication) of Tramadol dated 03/05/2020 and Diazepam (for valium) dated 03/05/2020.

I reviewed Resident E’s medication punch cards and I found for each of his prescribed medications starting with punch cards dated 07/22/2020 and each month thereafter, there were ten full medication punch cards and no partial medication punch cards found. Resident E had refused his medications.

On 03/03/2021, I telephoned the TLC Pharmacy and conducted an interview with Matthew Aldrich the Med Tech who had worked with Ms. Bouck. He stated that he was never notified by Ms. Bouck or any staff that they had any resident medications left over. If they had called and explained he would have advised them what to do. He also said he was never called by Ms. Wagner to request blank MARs. I asked if she could have spoken to any other staff and he said it was possible, but he was not aware of any such call. He said if someone knew how, they could pull the MARs off the electronic system, but it would be difficult unless you had that knowledge. He reported that their delivery date was in the middle of the month, but they had requested that the delivery of the residents’ medications be moved-up to better accommodate their needs for earlier in the month, so the delivery date was moved to the 10th of the month. I asked if he could produce the four/five resident’s MARs for me and he said he could. I asked him about Resident D’s liquid Tylenol, and he stated that she was prescribed six bottles a month with some left over in the last bottle. He said they were not notified when Resident D was in the hospital, so he sent the regular prescribed amounts. He stated he could not explain the excess of resident medications, especially the liquid Tylenol for Resident D unless she had extended hospital stays and even then, there was too much left over.

On 03/03/2021, I received and reviewed, by email, the one year’s MARs of the four residents. There were blanks on the MAR’s with no staff initials but not nearly enough to explain all the left-over medications.

On 03/18/2021 I conducted a telephone exit conference with Ms. Bouck, the licensee and she agreed with my findings.

17 APPLICABLE RULE R 400.1418 Resident medications.

(2) Medication shall be given pursuant to label instructions.

ANALYSIS: I received 26 pictures of resident medication punch cards and bottles of Tylenol from Angela Loiselle, Recipient Rights Director, from Montcalm Care Network. All of the medications were from past months.

Ms. Bouck acknowledged that if a resident punch card of medications had been completed the staff would pull a punch card from the bottom drawer, no matter the date on the punch card and use that card for administration of the resident’s prescribed medications.

Ms. Bouck stated that she and her staff administered all of the residents’ medications as prescribed. She also stated that she had destroyed resident medications once they expired.

Mr. Aldrich, the pharmacy Tech for LTC pharmacy, was unable to provide any explanation as to why there were so many resident medication punch cards left over. He confirmed that the pharmacy had not been notified of Resident E’s hospitalizations or that the home had resident punch cards that had not been used.

There is a preponderance of evidence, based on the amount of unused resident medication punch cards and the amount of liquid Tylenol prescribed for Resident E, that there is no explanation other than the residents did not consistently receive their medications on their prescribed dates and times.

CONCLUSION: VIOLATION ESTABLISHED

ALLEGATION: Ms. Wagner yells and screams at Resident E.

INVESTIGATION: On 02/16/2021 I received a Recipient Rights Complaint from Michelle Richardson, network 180, dated 02/15/2021.The written complaint stated that Resident E had initiated a conversation with his Behavioral Specialist, and he stated that he did not feel safe around Fran (Ms. Wagner) when she was working in the home because she yells and screams at him.

On 02/17/2021, Mr. Wilson, Recipient Rights, network 180, and I were in the home and we interviewed Ms. Bouck. She stated that the resident’s, have often told her

18 that Ms. Wagner is “mean.” Ms. Bouck stated that she did not remember Ms. Wagner yelling or screaming at Resident E.

While Mr. Wilson and I were in the home, Mr. Wilson asked Resident E if anyone yelled at him, and he said, “Yes Fran (Ms. Wagner). All she does is yell at me and give everyone a hard time.” When he was asked if anyone else has ever yelled at him, Resident E said, “No. Just Fran.” Resident E denied that Ms. Bouck had ever yelled at him.

On 03/17/2021, I conducted a telephone interview with Cora Santman, Resident A’s Behavioral Specialist. She stated that she was only allowed to do virtual visits during COVID-19, and she was not allowed into the AFC home, but on 01/20/2021, she saw Resident E and then she saw him on a weekly basis. She reported that she was at the home on 02/15/2021, for her weekly-in-person monitoring with Resident E. She explained that he expressed his concerns to her saying that he did not feel safe around Ms. Wagner when she is working in the home because she yells and screams at him. He also told her he did not feel comfortable taking showers/baths around Ms. Wagner. Ms. Santman stated that she told Resident E that he did not have to take a shower/bath while Ms. Wagner was working and that he had the right to refuse. She explained during their weekly in-person-monitoring Resident E has never brought these concerns up to her before. I asked Ms. Santman if Resident A is easily agreeable or persuaded with whatever is being presented to him. Ms. Santman stated that she would agree with that and stated Resident E will probably agree with whatever is being presented because he is looking for approval. She stated he had not expressed to her any concerns with Ms. Bouck or any of the other staff who provided direct care to him up to this point in time.

On 03/05/2021, I spoke by telephone with Angela Loiselle, Recipient Rights Director of Montcalm Community Care Network. She stated that she was in the home on 02/16/2021 and she was interviewing Ms. Bouck at the dining room table when Ms. Wagner entered the area. Ms. Loiselle explained that Ms. Wagner became aggressive, and she was shouting at Ms. Bouck. She stated that all the residents, including Resident E, became visibly upset. Ms. Loiselle reported that she had to ask Ms. Wagner to leave the home due to her inability to calm down.

On 03/17/2021, I conducted a telephone interview with Ms. Wagner. She stated that she did not yell or scream at Resident E and was “shocked” at the allegation. She reported she is not in the home every day. She said she has taken Resident E for his doctor’s appointments, pre surgery appointment, his recent surgery, and out to lunch. She said Resident E is easily manipulated.

On 03/18/2021 I conducted a telephone exit conference with Ms. Bouck the licensee and she agreed with my findings.

19 APPLICABLE RULE R 400.1409 Resident rights; licensee responsibilities.

(1) Upon a resident’s admission to the home, the licensee shall inform and explain to the resident or the resident’s designated representative all of the following resident rights: (o) The right to be treated with consideration and respect, with due recognition of personal dignity, individuality, and the need for privacy.

ANALYSIS: Ms. Bouck stated that she does not remember Ms. Wagner yelling or screaming at Resident E.

Ms. Santman, Resident A’s Behavioral Specialist, stated that Resident E reported Ms. Wagner yelled and screamed at him and he did not feel comfortable taking a shower or bath when Ms. Wagner was around.

Ms. Wagner denied that she has yelled or screamed at Resident E.

Mr. Wilson, Recipient Rights, asked Resident E if anyone yelled at him, and Resident E identified Ms. Wagner and he stated: “All she does is yell at me and give everyone a hard time.”

There is a not a preponderance of evidence that Resident E was treated with consideration, dignity or respect.

CONCLUSION: VIOLATION NOT ESTABLISHED

ALLEGATION: Ms. Bouck told Resident E he was not safe in the home, bitches at him, tells Resident B to shut up, and makes him stay in his room.

INVESTIGATION: On 02/16/2021 I received a Recipient Rights Complaint from Michelle Richardson, network 180, and it was noted that this incident happened on 01/26/2021 at 3:30 PM. but was not reported until 02/12/2021. The complaint in part read, Resident E told Ms. Wagner that he was upset that (Ms. Bouck) had told him that “I wasn’t safe to live in this home.” Resident B reportedly told Ms. Wagner that it upsets him when (Ms. Bouck) tells Resident B to “shut-up, all the time”. Resident E reportedly told Ms. Wagner that Ms. Bouck, “bitches” at him all the time and he dislikes her. He also was happy that Ms. Bouck was leaving because he didn’t like it when the baby cried during the day and Ms. Bouck made him stay in his room.

On 02/17/2021, we interviewed Ms. Bouck. She reported that she and Resident E had a good relationship and said, “He’s my buddy, and we get along well.” She explained that she would ask him to shower or change his shirt and he would do it.

20 She denied ever telling him that he was unsafe in the home. She said he has not ever reported to her that he felt unsafe. She reported that Resident E said he does not like Ms. Wagner. She denied that she has “bitched” at him at any time. She said when she asked him to complete his personal care, it was because it’s her job to do so. Ms. Bouck denied ever telling Resident B to “shut up.” When she was asked if Resident B would be able to respond to questions, she explained that she would not be able to remember due to her disability. She reported that she has seen Resident E visibly upset with Ms. Wagner’s yelling and he spends time in his room to avoid Ms. Wagner. Ms. Bouck acknowledged that she did have her baby with her at work, but she denied that that she had ever sent Resident E to his room or made him stay in his room. She stated that he chooses to go to his room because he had his TV and music.

On 03/17/2021, I conducted a telephone interview with Ms. Wagner. She stated that Resident E told her he was upset, and she asked him why. She reported that he was told that he wasn’t safe in this home. She asked who told him that and he said it was (Ms. Bouck). She reported that Resident E said Ms. Bouck “bitches” at him. She was unable to provide any examples presented by Resident E of what that means. She reported that Resident E told her that Ms. Bouck tells Resident B to “shut-up” all the time. Ms. Wagner said she brings food up to the main floor and she would have to go to Resident E’s bedroom to find him and she would ask him why he was in his room and he told her (Ms. Bouck) told him to go to his room. Ms. Wagner stated that she knew for sure this happened because others had also told her.

On 03/18 /2021, I conducted a telephone exit conference with Ms. Bouck the licensee and she agreed with my findings.

APPLICABLE RULE R 400.1409 Resident rights; licensee responsibilities.

ANALYSIS: Ms. Wagner acknowledged that Resident E told her, that Ms. Bouck had told him, that he was not safe in this home, Ms. Bouck bitches at him, tells Resident B to shut-up and she makes Resident E stay in his room.

Ms. Bouck denied telling Resident E that he was not safe in his room, denied “Bitching,” at him, denied telling Resident B to “Shut-up” and she denied making him stay in his room.

21 There was not a preponderance of evidence that Ms. Bouck had treated Resident E with consideration, respect or personal dignity.

CONCLUSION: VIOLAITON NOT ESTABLISHED

IV. RECOMMENDATION

The Licensee, Rose Bouck, has stated that she wants to relinquish her family home license. She has ended her CLS contacts with network 180 and Montcalm Care Network and all the residents have been discharged from the AFC home. Therefore, in lieu of negative action I recommend that our Department accept Ms. Bouck’s willingness to relinquish her licensee effective upon the signature date of this report.

03/19/2021 ______Arlene B. Smith, MSW Date Licensing Consultant

Approved By:

03/19/2021 ______Jerry Hendrick Date Area Manager