LARA is an equal opportunity employer/program.

CORRECTIVE ACTION PLANMichigan Department of Licensing and Regulatory Affairs

Bureau of Community and Health Systems

Licensee/Designee/Program Director Name Licensee/Designee/Program Director Signature Date

BCAL-1894 (Rev. 4-19) Previous edition may be used. MS Word 1 Distribution: copy for: Licensee/Designee/Program Directorcopy for: Licensing Consultant

Registration Number: Facility Name: Date of Violations

Violated Rule How Compliance Will Be Achieved, Monitored and Maintained Timeframe