Contact - Face to Face Resident A and Alexis McCurdy, hospital social worker. METHODOLOGY Special Investigation Intake 2017A /23/2017 APS Referral Rejected for investigation Special Investigation Initiated - Face to Face I interviewed LaTish Rutledge, home manager and observed Resident B. Resident A is hospitalized due to failed treatment for urinary tract infection, uncertain if the medication was administered as prescribed. ALLEGATION(S) Past marks and bruises were observed on Resident A and the explanation provided by staff doesn't seem consistent with the injury. IDENTIFYING INFORMATION License #: Investigation #: AS A Complaint Receipt Date: Investigation Initiation Date: Report Due Date: Licensee Name: Licensee Address: Domus Vita Inc Industrial Livonia, MI Licensee Telephone #: (734) Administrator: Licensee Designee: Name of Facility: Facility Address: Paula Parkin Paula Parkin Gallery Home 6450 Gallery Canton, MI Facility Telephone #: (734) Original Issuance Date: License Status: REGULAR Effective Date: Expiration Date: Capacity: 5 Program Type: DEVELOPMENTALLY DISABLED 1Ĥ II. BOX LANSING, MICHIGANģ MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF COMMUNITY AND HEALTH SYSTEMS SPECIAL INVESTIGATION REPORT I. Grand Blvd Detroit, MI (313) enclosure 611 W. In the event that I am not available and you need to speak to someone immediately, please contact the local office at (313) Sincerely, Denasha Walker, Licensing Consultant Bureau of Community and Health Systems Cadillac Pl. BOX LANSING, MICHIGANĢ Please review the enclosed documentation for accuracy and contact me with any questions. The signature of the responsible party and a date. How continuing compliance will be maintained once compliance is achieved. Specific time frames for each violation as to when the correction will be completed or implemented. Who is directly responsible for implementing the corrective action for each violation. The corrective action plan is due 15 days from the date of this letter and must include the following: How compliance with each rule will be achieved. Due to the violations identified in the report, a written corrective action plan is required. Parkin: Attached is the Special Investigation Report for the above referenced facility. 1 RICK SNYDER GOVERNOR STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING SHELLY EDGERTON DIRECTOR DecemPaula Parkin Domus Vita Inc Industrial Livonia, MI RE: License #: Investigation #: AS A Gallery Home Dear Ms.
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