STATE OF MICHIGAN
DEPARTMENT OF HUMAN SERVICES
BUREAU OF CHILDREN AND ADULT LICENSING
JENNIFER M. GRANHOLM
ISMAEL AHMED
GOVERNOR
DIRECTOR
June 3, 2009
Keven Pugh
42 W Burnham
Battle Creek, MI 49015
RE: Application #: AF130300311
Frances Family Home
42 W Burnham
Battle Creek, MI 49015
Dear Mr. Pugh:
Attached is the Original Licensing Study Report for the above referenced facility. The
study has determined substantial compliance with applicable licensing statutes and
administrative rules. Therefore, a temporary license with a maximum capacity of 2 is
issued.
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 (269) 337-5066.
Sincerely,
Vikita Walker, Licensing Consultant
Bureau of Children and Adult Licensing
322 E. Stockbridge Ave
Kalamazoo, MI 49001
(269) 337-5274
enclosure
P.O. BOX 30650 • LANSING, MICHIGAN 48909-8150
www.michigan.gov • (517) 335-6124
MICHIGAN DEPARTMENT OF HUMAN SERVICES
BUREAU OF CHILDREN AND ADULT LICENSING
LICENSING STUDY REPORT
I. IDENTIFYING INFORMATION
License #:
AF130300311
Applicant Name:
Keven Pugh
Applicant Address:
42 W Burnham
Battle Creek, MI 49015
Applicant Telephone #:
(269) 968-8449
Administrator/Licensee Designee:
N/A
Name of Facility:
Frances Family Home
Facility Address:
42 W Burnham
Battle Creek, MI 49015
Facility Telephone #:
(269) 968-8449
11/20/2008
Application Date:
Capacity:
5
Program Type:
DEVELOPMENTALLY DISABLED
PHYSICALLY HANDICAPPED
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II.
III.
METHODOLOGY
11/20/2008
Enrollment
11/24/2008
Application Incomplete Letter Sent
Items 1, 4, 44 and 49 on application
02/02/2009
Contact - Document Received
application & 1326 Keven
02/03/2009
Application Incomplete Letter Sent
Items 4, 8, 28, 51, 52, 53, 54, 55
02/10/2009
Application Incomplete Letter Sent
1326 for Kimberly
1326 for Kimberly Erskin, Responsible Person
03/04/2009
Contact - Document Received
1326 Kimberly
03/19/2009
Inspection Completed On-site
03/19/2009
Inspection Completed-BFS Sub. Compliance
04/29/2009
Inspection Completed-Full Compliance
DESCRIPTION OF FINDINGS & CONCLUSIONS
A. Physical Description of Facility
Property Ownership – Helen Robinson and Marvita Jones are the owners of the
property. They recently have purchase the property on Land contract with the intent of
allowing Kevin Pugh, Helen’s son to reside in. They have provided written
documentation of ownership for the property. Helen lives full time at the residence next
door to this facility.
Description of Structure – The facility is a small two bedroom home with a Michigan
basement. The furnace and water heater are located in the basement. The facility is
located in the City of Battle Creek, MI within walking distance of downtown. There are
two bedrooms, living room and dinning room. There is one full bath that meets licensing
requirements; it is near the south bedroom, which would be utilized by residents. The
basement has a cement floor but is not finished. The Licensee plans on finishing the
basement and will utilized it himself. It was once a garage and still has a garage door
that opens to the outside. Residents will not be utilizing the basement for living space. In
addition the washer and dryer are also located in the basement.
2
Square Footage of Bedrooms and Living SpaceBedroom#1
Bedroom#2
Living Room
Dinning Room
10 X 11
10 X 11
12 X 14
10 X 11
=
=
=
=
110 sq. ft.
110 sq. ft.
168 sq. ft.
110 sq. ft.
The total living space of 399 sq. ft. (excluding bedrooms, bathrooms, and kitchen and
laundry area) meets the total minimum living space for 2 residents and the Licensee.
Sanitation – The facility is located in the City of Battle Creek and is served by public
water and sewer. The kitchen is equipped with a stove, refrigerator, and hot / cold
water. It is recommended that the hot water temperature to the bathrooms be
monitored to not exceed 120 degrees Fahrenheit.
Fire Safety – The facility is equipped with a minimum one 2A10BC fire extinguisher on
the main floor of the home. There are two identified fire exits from the main floor. There
are smoke detectors throughout the home near the bedrooms and living areas.
Emergency procedures will be posted near the bedrooms housing residents. Fire drills
will be checked at renewal time to assure compliance with the fire safety rules.
B. Program Description
Description of the Organizational Structure – Keven Pugh is the sole licensee. The
licensee has identified Helen Robinson and Marvita Jones as responsible persons to
assist him with resident care. The licensee is aware that residents cannot be left alone
at anytime.
Good Moral Character – A Licensing Record Clearance Request form is contained in
the licensing record indicating good moral character for the licensee and family
members. Substantial compliance is achieved.
Financial Stability and Capability – A review of the application indicates compliance with
applicable rules regarding financial capability of the licensee. The Licensee works fulltime at Sunrise Senior Living located in Kalamazoo, MI.
Qualifications and Competencies:
Training – The licensee has previously worked with adults in foster care, mostly
veterans. The Licensee is currently working at Sunrise Senior Living as a nurse’s aid.
Helen Robinson also has previous experience in working with the elderly and is
presently working at the AARP Foundation for Michigan Works.
Health – The licensee has submitted a recent medical evaluation that indicates the
licensee is in good physical condition with no limitations. He also has TB test results
indicating negative response to testing. All the adult family members who will act as the
3
responsible party have also completed their medical clearances and their TB test results
were negative.
Program Information:
Admission/Discharge – No admission policy or discharge policy are required for a family
home. However the Licensee has developed some House Guidelines which also
covers admission and discharge procedures. The licensee has indicated his desire to
care for the developmentally delayed and physically handicapped. Smokers will not be
accepted. Wheelchair bound residents cannot be accommodated. Private pay and
public supported residents will be accepted.
Staffing Pattern – The licensee has appointed Helen Robinson as the administrator and
she will be the primary care provider. The Licensee will continue to work full-time at
Sunrise Senior Living. They have identified an additional person to assist with resident
care. The licensee is also aware of the requirements if he chooses to employ additional
help.
Transportation – The facility is able to provide transportation for residents to local
appointments within the Battle Creek area if relative or responsible persons are unable
to transport.
Recreation – Residential social/recreational activities include television, radio, and
stereo. Shopping is available in the local area as well as city parks for outdoor
activities.
Family and Employee Records:
Facility Records – a review of the application, emergency procedures, and fee policy
and house rules/guidelines indicate substantial compliance with the applicable rules.
The licensee has been provided all necessary forms.
Staff records – There are no staff records at the time of licensure. The licensee has
identified a responsible person for whom he will develop a file.
C. Rule/Statutory Violations
None.
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IV.
RECOMMENDATION
I recommend issuance of a temporary license for 2 physically handicapped and/or
developmentally disabled residents.
Vikita Walker
Licensing Consultant
06/02/2009
Date
Approved By:
Gregory V. Corrigan
Area Manager
06/03/2009
Date
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