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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