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Residential Care Services Investigation Summary Report
Provider/Facility: BROWNVILLE MANOR INC (687152) Intake ID(s): 3252697
License/Cert. #: AF550800Investigator: Singer, Jamie Region/Unit: RCS Region 2/Unit E Investigation
Date(s):11/18/201611/21/2016
through
Complainant Contact Date(s): 11/15/2016Allegations:#1. The Named Resident (NR) had bruises on and . The NR could not indicate the source of the bruises. TheNR flinches easily as if has been hit before.
Investigation Methods:Sample: Residents Observations: Adult Family Home
Environment, ResidentAppearance, Caregiver toResident Interaction
Interviews: Residents, Staff, Provider Record Reviews: Resident Records, StaffRecords, MedicationRecords
Allegation Summary:The NR appeared comfortable, well groomed, and relaxed in bedroom. In interview the NR did not recall having bruises,denied anyone hurt and felt safe in the home. Review of the NR medications found an order for a medication that can causebruising. The residents interacted easily with the caregiver. In interview with the residents there were no concerns regardingcare and services.
Unalleged Violation(s):See Statement of Deficiencies dated 11/21/2016.
Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
See Statement of Deficiencies dated 11/21/2016.
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