Failure to Maintain Resident Trust Fund Accounting
Summary
The facility failed to establish and maintain a system that assures complete and separate accounting for residents' trust funds from the facility's operating account. This deficiency was identified through a complaint received by the State Agency, which revealed that a resident's guardian had repeatedly requested financial statements and account audits since December 2023 but received no satisfactory response. The facility's business manager was fired, and the role was left unfilled for a period, leading to further delays and confusion. The resident's guardian reported ongoing issues with the trust fund, including being informed that the account was overdrawn despite having funds available, and not receiving any trust fund account statements for over a year. The facility's records confirmed that the monthly patient allowances were not credited timely to the resident's trust fund account, with a lump sum credit being made only in April 2024, just before the account was closed at the guardian's request. Interviews with the facility's business office manager in training and the regional business office manager revealed that the facility had a process for mailing out quarterly account statements, but the last statement was mailed in April for the period of January through March. The regional business office manager admitted that the facility had to move the credit from their operating account to the trust fund account, which was not done timely. The facility administrator confirmed that they had spoken with the resident's guardian multiple times but did not document these grievances. The administrator also acknowledged that the business office manager no longer worked at the facility and that the regional business office manager was assisting the guardian. The facility's policy on resident trust funds required accurate accounting and safe handling of resident funds, including timely crediting of funds and regular review of accounts. However, the facility failed to adhere to these policies, resulting in the resident's guardian being uninformed about the resident's personal funds and the potential for misuse of those funds. The facility's failure to provide timely financial statements and maintain a separate accounting system for the resident's trust funds led to significant confusion and concern for the resident's guardian.
Penalty
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The facility did not timely update resident trust account records, causing multiple accounts to show negative balances that staff acknowledged did not reflect actual resident funds. Fourteen residents with various chronic conditions, including dementia, schizophrenia, depression, COPD, and DM, were affected, with negative balances ranging from small amounts to over one thousand dollars. Staff interviews revealed that the Business Office Manager relied on the Executive Director to provide information on cashed checks and cost-of-care payments, and both the Administrator and Executive Director admitted they were behind on bookkeeping and documentation. Facility policies allowed residents or their representatives to request account balances and detailed fund activity, but the delayed updates meant the financial records were not accurate at the time of review.
A resident with a personal trust fund account did not receive required quarterly statements, leaving them unaware of their account balance despite multiple requests. The Business Office Manager confirmed that no statements had been provided to any residents or guardians, in violation of facility policy.
The facility did not properly hold, secure, and manage a resident's personal money that was deposited with the facility, resulting in improper handling of the resident's funds.
Quarterly statements for resident fund accounts were not mailed to the designated guardians or primary financial contacts, but instead were sent to the residents at the facility address. This failure was confirmed by interviews with financial contacts and the Business Office Manager, and was not in accordance with signed agreements or facility policy.
The facility failed to maintain accurate and accessible accounting of resident trust accounts, affecting three residents. Discrepancies in account balances were found, and quarterly statements were not provided. The issue arose after a change in facility ownership, leading to a lack of transparency and adherence to policies regarding the management of residents' personal funds.
A resident with intact cognition and multiple diagnoses, including diabetes and Parkinson's, did not receive quarterly statements for her personal funds, as required by the facility's policy. Despite authorizing the facility to manage her funds, there was no documentation of statements being provided, which was confirmed by both the resident and the Business Office Manager.
Untimely Resident Trust Account Updates Result in Inaccurate Negative Balances
Penalty
Summary
The facility failed to properly hold, secure, and manage residents' personal funds by not keeping resident trust account financial records timely updated, resulting in multiple accounts showing negative balances. Fourteen residents' financial records were reviewed, and each showed a negative balance as of 02/27/26, despite facility leadership stating that most of these residents did not actually have negative balances. The residents involved had a range of medical diagnoses, including hypertension, dementia, schizophrenia, major depressive disorder, COPD, diabetes, and other chronic conditions, and several had documented cognitive impairments ranging from mild to severe, while others were cognitively intact. Specific review of each resident's trust account information dated 02/27/26 revealed negative balances varying in amount. One resident had a negative balance of -$970.99, another had -$31.45, and others had negative balances such as -$59.09, -$77.14, -$110.97, -$31.57, -$56.96, -$44.47, -$4.73, -$18.97, -$64.57, -$39.72, and -$36.71. One resident's account showed a significantly larger negative balance of -$1,819.10. These negative balances were documented for residents with differing cognitive statuses, including residents whose MDS assessments showed severe cognitive impairment, mild cognitive impairment, intact cognition, and some whose cognitive status had not yet been evaluated. Interviews with facility staff confirmed that the negative balances were largely due to delays and backlogs in bookkeeping and updating of financial records, rather than actual overspending by residents. The Business Office Manager stated that many resident financial records were not up to date and that she depended on the Executive Director to provide information about cashed checks and cost-of-care payments before she could update the accounts. The Administrator acknowledged that the facility was behind in paperwork and bookkeeping, resulting in resident financial records reflecting negative balances that did not correspond to the residents' true financial status. The Executive Director confirmed he could fall behind on documenting resident financial expenses and revenues and that most residents with negative balances did not truly have negative balances because the records had not yet been updated. Facility policies stated that residents are permitted to manage their personal funds or, if managed by the facility, to receive quarterly statements and to obtain their account balances and written breakdowns of fund activity upon request, underscoring the requirement for accurate and timely financial recordkeeping that was not being met.
Failure to Provide Quarterly Resident Trust Fund Statements
Penalty
Summary
The facility failed to provide quarterly statements to residents with personal trust fund accounts, as required by both facility policy and the signed Resident Fund Management Service Authorization Agreement. Record review showed that a resident who had authorized the facility to manage their funds did not receive any quarterly statements for their account, despite the agreement specifying that statements would be provided at least quarterly. The resident's account had a balance, but the resident reported not receiving statements and being unaware of the account balance, even after making multiple requests for this information. An interview with the Business Office Manager confirmed that no quarterly statements had been distributed to residents or their guardians. The facility's policy requires accurate and timely information to be provided to residents regarding their personal funds, but this was not followed. The deficiency was identified through record review, resident and staff interviews, and policy review, affecting at least one resident directly, with the potential to impact others with similar accounts.
Failure to Properly Manage Resident Personal Funds
Penalty
Summary
The facility failed to properly hold, secure, and manage each resident's personal money that was deposited with the nursing home. This deficiency indicates that the required procedures for safeguarding residents' funds were not followed, resulting in improper management of personal monies entrusted to the facility by residents.
Failure to Mail Resident Fund Statements to Designated Financial Contacts
Penalty
Summary
The facility failed to ensure that quarterly statements for resident funds accounts were mailed to the individuals identified as the guardian or primary financial contact for several residents. Specifically, for three residents reviewed, the statements were instead addressed and sent to the residents at the facility's address, rather than to their designated financial contacts as required by the signed Resident Fund Management Service Authorization Agreements. These agreements, signed by the responsible parties, clearly indicated that the person signing would receive quarterly statements. Interviews with the residents' financial contacts confirmed that they had not received the required statements and were unaware of the account balances. The Business Office Manager confirmed that a third-party service was used to mail out the statements, and that the statements were sent to the address listed at the top of the statement, which was the facility address for all affected residents. Review of facility policy indicated that statement addresses were to be correct, but this was not followed. The deficiency affected three out of six residents reviewed for resident funds, with the facility identifying a total of 50 residents with personal funds accounts.
Deficiency in Managing Resident Trust Accounts
Penalty
Summary
The facility failed to maintain a complete, accurate, and accessible accounting of resident trust accounts and did not provide quarterly statements to residents. This deficiency affected three residents who had their personal funds managed by the facility. The facility's policy required that funds be managed in accordance with federal and state requirements, including providing quarterly statements and maintaining accurate records of all financial transactions. However, the facility did not adhere to these policies, resulting in discrepancies in the residents' account balances and a lack of transparency regarding their financial status. Resident #1, who was moderately cognitively impaired, had a discrepancy of $65.00 in his account balance. His daughter, who was responsible for his finances, confirmed that she had not received any quarterly statements or updates regarding his account. Similarly, Resident #2, who was cognitively intact, had a discrepancy of $100.00 in her account balance and reported not receiving any recent statements. Resident #3, who was also cognitively intact, had a discrepancy of $10.00 in her account balance, and her Power of Attorney was not reachable for comment. All three residents were unaware of their current account balances due to the facility's failure to provide the necessary financial information. The issue arose when a new company took over ownership of the facility, and the Business Office Manager reported being unable to access the system to log accounting or run quarterly statements. The facility's corporate staff eventually provided some account details, but the information was not timely or accurate. The Administrator confirmed that account statements were not provided when the accounts were closed and transferred to the new company. The facility's failure to manage the residents' personal funds in accordance with their policies and federal/state requirements led to the identified discrepancies and lack of transparency in the residents' financial records.
Failure to Provide Quarterly Personal Fund Statements
Penalty
Summary
The facility failed to provide quarterly statements for personal funds to a resident, which is a requirement as per their policy. The deficiency was identified during a review of the medical record, staff and resident interviews, and policy review. The affected resident, admitted on 09/11/17, had diagnoses including type two diabetes mellitus, bipolar disorder, Parkinson's disease, and hypertension, and was noted to have intact cognition according to a recent MDS assessment. The resident had authorized the facility to manage her personal fund account, but there was no documentation that she received quarterly statements. During an interview, the resident confirmed that she had not been provided with a copy of her quarterly statement in the past year. The Business Office Manager verified the absence of documentation for the quarterly statements, which is contrary to the facility's policy revised in 04/2017.
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