Failure to Properly Manage Resident's Personal Funds
Summary
The facility failed to obtain authorization to manage personal funds, properly manage a trust account, and follow its own policy on personal funds and trust accounts for a resident. The incident began when the resident reported that $50 was stolen from their wallet during the nighttime hours. The facility conducted an investigation but found no evidence to substantiate the missing money. The resident's durable power of attorney (DPOA) was notified, and a police report was made. The facility's investigation concluded that the money was not substantiated as missing, suggesting that the resident might have spent it on food or vending machines. However, the resident insisted that they had placed the money in their wallet under their pillow, as they did every night, and found it missing the next morning. The facility's records showed that the resident received money from their DPOA, which was held and distributed by the facility, but there was no official trust account in place as the DPOA had allegedly refused it. However, the signed contract did not indicate a refusal of a trust account. Further interviews revealed inconsistencies in the facility's handling of the resident's funds. The DPOA stated that they regularly gave money to the facility to be deposited into the resident's account and received receipts for these deposits. However, the DPOA did not receive monthly or quarterly statements of the account balance. The Assistant Administrator (AA) confirmed that the resident received money from the DPOA but could not provide a clear explanation of how the funds were managed without an official trust account. The AA also could not substantiate the missing money, suggesting that the resident might have spent it. The facility's failure to properly manage the resident's funds and maintain accurate records led to the deficiency cited in the report.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Residents were unable to access their personal funds outside of regular business office hours, as confirmed by staff and resident interviews. Personal funds were not available after 4:00 P.M. on weekdays, nor on weekends or holidays, and there was no alternative method for residents to obtain money when the business office was closed.
A resident's right to manage their own financial affairs was not honored, resulting in a violation of federal regulations regarding resident autonomy.
A resident with depression and quadriplegia did not receive a required $50 social security allowance for one month after a delay in the deposit of their check. The facility's system failed to recognize the need for a retroactive payment, resulting in the resident not receiving the allowance for that period, as confirmed by business office staff and record review.
The facility did not ensure residents could access their personal funds after business hours or on weekends. Only one staff member was responsible for distributing funds, and no process was in place for other staff to provide access outside of regular hours. Multiple staff and residents confirmed that this led to frustration and delays in accessing personal money, with some residents waiting days or being unable to obtain funds when needed.
A resident was unable to access personal funds outside of standard business hours and on weekends, as confirmed by staff interviews and facility policy review. The facility's process limited fund access to weekdays, and the policy lacked guidance for after-hours or weekend withdrawals, resulting in delayed access for the resident.
The facility did not obtain properly witnessed written authorization forms before managing the personal funds of two residents, as required by policy. Although representatives signed the consent forms, the witness signature sections were left blank, resulting in incomplete authorization documentation.
Failure to Provide Resident Access to Personal Funds After Business Hours
Penalty
Summary
The facility failed to make residents' personal funds available outside of regular business office hours, affecting three residents reviewed for access to their funds. Residents reported being unable to obtain money from their personal accounts after 4:00 P.M. on weekdays, as well as on weekends and holidays, due to the business office being closed. Staff interviews confirmed that personal funds are not kept in the medication cart or otherwise accessible when the business office is closed. One resident was unaware of how much money was available or how to access it, only knowing that someone would assist with purchases when needed. Observations confirmed that posted banking hours were limited to Monday through Friday, 8:00 A.M. to 4:00 P.M., and that the business office was inconsistently open during the survey period.
Failure to Honor Resident's Right to Manage Financial Affairs
Penalty
Summary
A deficiency was identified regarding the facility's failure to honor a resident's right to manage his or her own financial affairs. The report notes that the resident's autonomy in handling personal finances was not respected, which is a violation of resident rights as outlined in federal regulations. No additional details about the specific actions or inactions, the resident's medical history, or their condition at the time of the deficiency are provided in the report.
Failure to Provide Resident Social Security Allowance Due to Missed Retroactive Payment
Penalty
Summary
The facility failed to ensure that a resident had access to his social security allowance as required. The resident, who was cognitively intact and had diagnoses including depression and quadriplegia, had his social security check for February recalled by Social Security and not deposited until April. As a result, the system did not recognize that the resident should have received his $50.00 allowance retroactively for February. The resident did not receive this allowance, even though subsequent months' allowances were properly allotted and withdrawn by the resident as documented by signed receipts. Interview with the Regional Business Office Manager confirmed that the oversight occurred because the system did not account for the late deposit of the February check, and the resident was not given his $50.00 allowance for that month. This deficiency was identified during a review of the resident's personal fund statements and was verified through interviews and record review.
Failure to Provide Resident Access to Personal Funds After Hours
Penalty
Summary
The facility failed to ensure that residents had access to their personal funds after business hours and on weekends. Four residents with personal funds accounts managed by the facility were affected. Observations and interviews revealed that only one staff member, HR #153, was responsible for dispensing resident funds, and she did not leave the money box accessible to other staff after her shift ended at 5:00 P.M. on weekdays or on weekends. Multiple staff members, including RNs, LPNs, and CNAs, confirmed they did not have access to the funds box outside of business hours, and residents were required to withdraw money before HR #153 left for the day. Residents reported being unable to access their funds after hours and on weekends, with some stating they had to wait days to receive money or that the facility had run out of money in the personal funds box. Staff interviews corroborated that residents voiced frustration and concerns about not having timely access to their funds. Review of the facility's policy indicated a requirement to comply with federal and state regulations regarding resident funds, but the observed practices did not align with this policy.
Failure to Provide Resident Access to Personal Funds Outside Business Hours
Penalty
Summary
The facility failed to ensure that residents had access to their personal funds outside of normal business hours and on weekends. Interviews with staff revealed that residents could only access their personal funds Monday through Friday, from 8:00 A.M. to 5:00 P.M., and were unable to obtain money on weekends. The Business Office Manager and receptionists confirmed these restricted hours, and the facility policy did not specify procedures for accessing funds after hours or on weekends. A resident with intact cognition reported previous difficulties in obtaining money, stating it typically took at least three days to receive requested funds and that they did not attempt to access funds outside business hours because they knew it was not possible. The Administrator stated an expectation that residents should have access to their funds seven days a week, but this was not reflected in practice or policy. This deficiency was identified during a complaint investigation and affected at least one resident reviewed for personal funds.
Failure to Obtain Proper Written Authorization for Management of Resident Funds
Penalty
Summary
The facility failed to obtain appropriate written authorization to manage the personal funds of two residents. For both residents, the authorization forms allowing the facility to manage their funds were signed by their representatives, but the required witness signatures were missing. The forms included designated spaces for two witnesses, but these were left blank. This was confirmed during an interview with the Administrator, who acknowledged that the proper written authorization had not been obtained for these residents. The residents involved had significant medical histories, including diagnoses such as cerebral infarction, hypotension, anxiety disorder, cerebral vascular accident, transient ischemic attack, and dementia. Despite the facility's policy requiring written designation when accepting responsibility for a resident's financial affairs, the lack of witnessed signatures on the authorization forms constituted a failure to follow this policy.
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