State of Michigan DEPARTMENT OF HUMAN SERVICES June 19 ...

RICK SNYDER
GOVERNOR
June 19, 2013
John Cornack
Moriah Incorporated
3200 E Eisenhower
Ann Arbor, MI 48108
RE: License #:
Investigation #:
Dear Mr. Cornack:
State of Michigan
DEPARTMENT OF HUMAN SERVICES
BUREAU OF CHILDREN AND ADULT LICENSING
AL810069928
2013A0772013
Eisenhower Center North Hall
P.O. BOX 30650 • LANSING, MICHIGAN 48909-8150
www.michigan.gov • (517) 335-6124
MAURA D. CORRIGAN
DIRECTOR
Attached is the Special Investigation Report for the above referenced facility. Due to
the violations identified in the report, a written corrective action plan is required. 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.
• Who is directly responsible for implementing the corrective action for each
violation.
• Specific time frames for each violation as to when the correction will be
completed or implemented.
• How continuing compliance will be maintained once compliance is
achieved.
• The signature of the responsible party and a date.
• Specific time frames for each violation as to when the correction will be
completed or implemented.
• Indicate how continuing compliance will be maintained once compliance
is achieved.
• Be signed and dated.
If you desire technical assistance in addressing these issues, please feel free to contact
me. In any event, the corrective action plan is due within 15 days.

Please review the enclosed documentation for accuracy and feel free to contact me with
any questions. In the event that I am not available and you need to speak to someone
immediately, please feel free to contact the local office at (517) 373-2506.
Sincerely,
Karen Davis, Licensing Consultant
Bureau of Children and Adult Licensing
301 E. Louis Glick Hwy
Jackson, MI 49201
(517) 262-8574
enclosure

I. IDENTIFYING INFORMATION
MICHIGAN DEPARTMENT OF HUMAN SERVICES
BUREAU OF CHILDREN AND ADULT LICENSING
SPECIAL INVESTIGATION REPORT
License #: AL810069928
Investigation #: 2013A0772013
Complaint Receipt Date: 02/06/2013
Investigation Initiation Date: 02/06/2013
Report Due Date: 04/07/2013
Licensee Name: Moriah Incorporated
Licensee Address: 3200 E Eisenhower
Ann Arbor, MI 48108
Licensee Telephone #: (734) 677-0070
Administrator: John Cornack
Licensee Designee: John Cornack
Name of Facility: Eisenhower Center North Hall
Facility Address: 3200 E Eisenhower Parkway
Ann Arbor, MI 48108
Facility Telephone #: (734) 677-0070
Original Issuance Date: 02/09/1996
License Status: REGULAR
Effective Date: 01/07/2011
Expiration Date: 01/06/2013
Capacity: 15
Program Type: PHYSICALLY HANDICAPPED
TRAUMATICALLY BRAIN INJURED
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II. ALLEGATION(S)
Resident A eloped from the facility on 02/04/13.
III. METHODOLOGY
02/06/2013 Special Investigation Intake
2013A0772013
02/06/2013 Special Investigation Initiated - Telephone
Christine Myran, staff person.
02/13/2013 Inspection Completed On-site
03/22/2013 Telephone Contact – Ethan Terrell, staff person
04/15/2013 Exit conference
Christine Myran
05/31/2013 Exit conference
Licensee Designee John Cornack
ALLEGATION:
Resident A eloped from the facility on 02/04/13.
INVESTIGATION:
On 02/06/13, a written incident report from Eisenhower Center North Hall was
received. Resident A eloped from the facility during the midnight shift. Samantha
Hamilton was a staff person assigned to make periodic “eyes-on” checks on the
resident. The facility’s written incident report noted the last time Resident A was
seen as 11:30 pm on 02/03/13. Samantha Hamilton wrote the report and noted that
the lead staff person gave permission to Resident A to wash his clothes at another
licensed adult foster care facility on the Eisenhower Center campus. Ms. Hamilton
noted that she called the other facility to check if Resident A was alright. Ms.
Hamilton also noted on the written incident report that she went over to the other
facility to check on Resident A. Resident A was socializing with his peers and Ms.
Hamilton returned to Eisenhower Center North Hall.
On 02/13/13, I conducted an on-site investigation at the facility. I reviewed the
facility records of Resident A and his Assessment Plan noted that he could not
safely move about in the community independently. Resident A was to be
supervised while in the community.
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I interviewed Christine Myran, staff member, who stated that once the elopement of
Resident A was discovered, an exhaustive search of the facility and the entire
Eisenhower Center campus was conducted. Ms. Myran stated that a review of the
video tapes taken of the outside campus show a white car picking up Resident A from
the Eisenhower parking lot at 11:25 pm. The description of the car and license plate
number were given to the police. The information was also given to Resident A’s
legal guardian.
On 03/22/13, I conducted a telephone interview with lead staff person Ethan Terrell.
Mr. Terrell stated that before the end of the afternoon shift Resident A asked him if
he could wash a large load of clothes at another Eisenhower campus facility because
of its larger industrial washer and dryers. Mr. Terrell granted permission for Resident
A to wash his clothes late that evening, around 11pm, unsupervised. The on-coming
midnight shift was making rounds and discovered Resident A was missing. Mr. Terrell
stated the units were searched and the outside area of the facility was searched.
Ms. Myran stated that Ms. Hamilton’s employment with Eisenhower Center was
terminated as a result of Resident A’s elopement because Ms. Hamilton failed to
monitor Resident A every 15 minutes. Mr. Terrell received a three-day suspension for
his handling of the incident.
Resident A returned to the facility on 04/15/2013. Ms. Myran stated that Resident A
was picked up in Utica MI by the police. He was trying to make a doctor’s.
appointment and his insurance provider alerted his legal guardian and police.
I conducted an exit conference via the telephone on 05/31/13 with licensee
Mr. John Conrack. Mr. Conrack confirmed that because of Resident A’s elopement
disciplinary action was taken against Ms. Hamilton and Mr. Terrell. Mr. Conrack also
stated that the facility procedures will be revised in regard to
visually monitoring resident movement from one campus facility to another. He is
now aware that movement from one facility to another within the Eisenhower campus
is considered the community. Residents who must be supervised in the community,
must be supervised when going from one facility to another on the Eisenhower
campus. We also discussed if the facility determines that the resident is capable of
going into the community for a period of time “on a pass” this should be stated in his
Assessment Plan.
APPLICABLE RULE
R 400.15305 Resident protection.
(3) A resident shall be treated with dignity and his or her
personal needs, including protection and safety, shall be
attended to at all times in accordance with the provisions of the
act.
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ANALYSIS: The facility staff did not properly supervise Resident A. The
Assessment Plan requirement that he be supervised while in the
community was not followed. Resident A’s was not visually
monitored every 15 minutes. Resident A was not provided the
supervision and protection he needed in the community.
CONCLUSION: VIOLATION ESTABLISHED
IV. RECOMMENDATION
Contingent upon receipt of an acceptable corrective action plan, I recommend the
status of the license remain the same.
06/17/13
________________________________________
Karen Davis
Date
Licensing Consultant
Approved By:
6/17/13
________________________________________
Betsy Montgomery
Date
Area Manager
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